Treatment using truncated trk b and trk c antagonists

ABSTRACT

Disclosed herein are methods, compositions, vectors, and kits comprising an antagonist of a truncated TrkC or a truncated TrkB. Also described herein are methods of treating and/or preventing an otic disease or condition associated with an elevated expression level of a truncated TrkC or truncated TrkB isoform.

CROSS-REFERENCE

This application claims the benefit of U.S. Provisional Application No. 62/198,062, filed Jul. 28, 2015, which application is incorporated herein by reference.

SEQUENCE LISTING

The instant application contains a Sequence Listing which has been submitted electronically in ASCII format and is hereby incorporated by reference in its entirety. Said ASCII copy, created on Jul. 28, 2016, is named 37173-832_601 _SL.txt and is 97,604 bytes in size.

BACKGROUND OF THE INVENTION

Neuron loss such as sensory neuron loss is the cause of morbidity in many otic related neurodegenerative diseases. In some instances, sensory neurons express Trk family of receptors such as TrkB and/or TrkC. Activity of the Trk family of receptors correlates with sensory neuron survival or death, maintenance of synapses and phenotype, and function.

SUMMARY OF THE INVENTION

Disclosed herein, in certain embodiments, is a method of treating an otic disease or condition or a symptomatic or pre-symptomatic condition with alterations of otic synapses, comprising administering to a patient in need thereof a therapeutic amount of a pharmaceutical composition comprising: (a) an antagonist of truncated TrkC or truncated TrkB, wherein the antagonist induces a decrease in the truncated TrkC or truncated TrkB expression level or activity or impedes the truncated TrkC or truncated TrkB interaction with a truncated TrkC or truncated TrkB binding partner; and (b) a pharmaceutically acceptable excipient and/or a delivery vehicle. Also disclosed herein is a method of preventing an otic disease or condition or reducing the progression of an otic disease or condition, comprising administering to a patient in need thereof a therapeutic amount of a pharmaceutical composition comprising: (a) an antagonist of truncated TrkC or truncated TrkB, wherein the antagonist induces a decrease in the truncated TrkC or truncated TrkB expression level or activity or impedes the truncated TrkC or truncated TrkB interaction with a truncated TrkC or truncated TrkB binding partner; and (b) a pharmaceutically acceptable excipient and/or a delivery vehicle. In some embodiments, the otic disease or condition comprises a disease or condition associated with hearing loss. In some embodiments, the otic disease or condition comprises ototoxicity, chemotherapy induced hearing loss, excitotoxicity, sensorineural hearing loss, noise induced hearing loss, presbycusis, Meniere's Disease/Syndrome, endolymphatic hydrops, labyrinthitis, Ramsay Hunt's Syndrome, vestibular neuronitis, tinnitus, or microvascular compression syndrome. In some embodiments, the antagonist that induces a decrease in the truncated TrkC or truncated TrkB expression level or activity is a nucleic acid polymer, a polypeptide, or a small molecule. In some embodiments, the antagonist that induces a decrease in the truncated TrkC or truncated TrkB expression level or activity is a nucleic acid polymer. In some embodiments, the nucleic acid polymer hybridizes to a target sequence of the truncated TrkC or truncated TrkB mRNA. In some embodiments, the nucleic acid polymer hybridizes to a target sequence that is located at the 3′UTR region of the truncated TrkC or truncated TrkB mRNA. In some embodiments, the nucleic acid polymer hybridizes to a target sequence comprising a binding motif selected from CCAAUC, CUCCAA, or ACUGUG. In some embodiments, the nucleic acid polymer comprises a short hairpin RNA (shRNA) molecule, a microRNA (miRNA) molecule, a siRNA molecule, or a double stranded RNA molecule. In some embodiments, the nucleic acid polymer is a shRNA molecule. In some embodiments, the nucleic acid polymer comprises at least 80%, 85%, 90%, 95%, or 99% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some embodiments, the nucleic acid polymer comprises 100% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some embodiments, the nucleic acid polymer consists of a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some embodiments, the nucleic acid polymer comprising at least 80%, 85%, 90%, 95%, or 99% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some embodiments, the nucleic acid polymer comprising 100% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some embodiments, the nucleic acid polymer consisting of a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some embodiments, the nucleic acid polymer comprising at least 80%, 85%, 90%, 95%, or 99% sequence identity to a nucleic acid sequence that hybridizes to a target sequence of the truncated TrkB. In some embodiments, the nucleic acid polymer comprising 100% sequence identity to a nucleic acid sequence that hybridizes to a target sequence of the truncated TrkB. In some embodiments, the nucleic acid polymer comprising at least 80%, 85%, 90%, 95%, or 99% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some embodiments, the nucleic acid polymer comprising 100% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some embodiments, the nucleic acid polymer consisting of a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some embodiments, the nucleic acid polymer is further modified at the nucleoside moiety, at the phosphate moiety, or a combination thereof. In some embodiments, the nucleic acid polymer further comprises one or more artificial nucleotide bases. In some embodiments, the one or more artificial nucleotide bases comprises 2′-O-methyl, 2′-O-methoxyethyl (2′-O-MOE), 2′-O-aminopropyl, 2′-deoxy, T-deoxy-2′-fluoro, 2′-O-aminopropyl (2′-O-AP), 2′-O-dimethylaminoethyl (2′-O-DMAOE), 2′-O-dimethylaminopropyl (2′-O-DMAP), T-O-dimethylaminoethyloxyethyl (2′-O-DMAEOE), or 2′-O-N-methylacetamido (2′-O-NMA) modified, locked nucleic acid (LNA), ethylene nucleic acid (ENA), peptide nucleic acid (PNA), 1′, 5′-anhydrohexitol nucleic acids (HNA), morpholino, methylphosphonate nucleotides, thiolphosphonate nucleotides, or 2′-fluoro N3-P5′-phosphoramidites. In some embodiments, the nucleic acid polymer is at most 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 70, 80, 90, or 100 nucleotides in length. In some embodiments, the pharmaceutical composition comprising the nucleic acid polymer is administered to a patient in need thereof as an intramuscular, intratympanic, intracochlear, intravenous or subcutaneous administration. In some embodiments, the method further comprises a vector comprising the nucleic acid polymer. In some embodiments, the vector is a viral vector. In some embodiments, the viral vector is a lentiviral vector, a retroviral vector, an adenoviral vector, an adeno-associated viral vector, an alphaviral vector, a herpes simplex virus vector, a vaccinia viral vector, or a chimeric viral vector. In some embodiments, the antagonist that impedes the truncated TrkC or truncated TrkB interaction with a truncated TrkC or truncated TrkB binding partner is a small molecule or a polypeptide. In some embodiments, the antagonist that impedes the truncated TrkC or truncated TrkB interaction with a truncated TrkC or truncated TrkB binding partner is a small molecule. In some embodiments, the small molecule is a peptidomimetic. In some embodiments, the small molecule is a small molecule as illustrated in FIG. 2. In some embodiments, the antagonist that impedes the truncated TrkC or truncated TrkB interaction with a truncated TrkC or truncated TrkB binding partner is a polypeptide. In some embodiments, the polypeptide is an antibody or binding fragment thereof. In some embodiments, the antibody or binding fragment thereof comprises a humanized antibody or binding fragment thereof, chimeric antibody or binding fragment thereof, monoclonal antibody or binding fragment thereof, monovalent Fab′, divalent Fab2, single-chain variable fragment (scFv), diabody, minibody, single-domain antibody (sdAb), or camelid antibody or binding fragment thereof. In some embodiments, the truncated TrkC is a non-catalytic truncated TrkC. In some embodiments, the truncated TrkC protein comprises at least 80%, 85%, 90%, 95%, or 99% sequence identity to the amino acid sequence of SEQ ID NO: 10 or 113. In some embodiments, the truncated TrkC protein consists of the amino acid sequence of SEQ ID NO: 10 or 113. In some embodiments, the truncated TrkC is TrkC.T1. In some embodiments, the truncated TrkB is a non-catalytic truncated TrkB. In some embodiments, the truncated TrkB protein comprises at least 80%, 85%, 90%, 95%, or 99% sequence identity to an amino acid sequence selected from SEQ ID NOs: 11-12 and 121-123. In some embodiments, the truncated TrkB protein consists of an amino acid sequence selected from SEQ ID NOs: 11-12 and 121-123. In some embodiments, the truncated TrkB is TrkB.T1. In some embodiments, the truncated TrkC binding partner comprises a neurotrophin or a microRNA molecule. In some embodiments, the neurotrophin is neurotrophin-3 (NT-3). In some embodiments, the microRNA molecule comprises miR-128, miR-509, or miR-768-5p. In some embodiments, the truncated TrkB binding partner comprises a neurotrophin. In some embodiments, the neurotrophin is brain derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), or neurotrophin-4 (NT-4). In some embodiments, the pharmaceutical composition is administered for intramuscular, intratympanic, intracochlear, intravenous or subcutaneous administration.

Disclosed herein, in certain embodiments, is a method of treating an otic disease or condition, comprising administering to a patient in need thereof a therapeutic amount of a pharmaceutical composition comprising: (a) a nucleic acid polymer that hybridizes to a target sequence of truncated TrkC or truncated TrkB, wherein the nucleic acid polymer is capable of decreasing the expression level of the truncated TrkC or truncated TrkB; and (b) a pharmaceutically acceptable excipient and/or a delivery vehicle. Also disclosed herein, in certain embodiments, is a method of preventing an otic disease or condition or reducing the progression of an otic disease or condition, comprising administering to a patient in need thereof a therapeutic amount of a pharmaceutical composition comprising: (a) a nucleic acid polymer that hybridizes to a target sequence of truncated TrkC or truncated TrkB, wherein the nucleic acid polymer is capable of decreasing the expression level of the truncated TrkC or truncated TrkB; and (b) a pharmaceutically acceptable excipient and/or a delivery vehicle. In some embodiments, the otic disease or condition comprises a disease or condition associated with hearing loss. In some embodiments, the otic disease or condition comprises ototoxicity, chemotherapy induced hearing loss, excitotoxicity, sensorineural hearing loss, noise induced hearing loss, presbycusis, Meniere's Disease/Syndrome, endolymphatic hydrops, labyrinthitis, Ramsay Hunt's Syndrome, vestibular neuronitis, tinnitus, or microvascular compression syndrome. In some embodiments, the target sequence is located at the 3′UTR region of the truncated TrkC or truncated TrkB mRNA. In some embodiments, the nucleic acid polymer hybridizes to a target sequence comprising a binding motif selected from CCAAUC, CUCCAA, or ACUGUG. In some embodiments, the nucleic acid polymer comprises a short hairpin RNA (shRNA) molecule, a microRNA (miRNA) molecule, a siRNA molecule, or a double stranded RNA molecule. In some embodiments, the nucleic acid polymer is a shRNA molecule. In some embodiments, the nucleic acid polymer comprises at least 80%, 85%, 90%, 95%, or 99% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some embodiments, the nucleic acid polymer comprises 100% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some embodiments, the nucleic acid polymer consists of a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some embodiments, the nucleic acid polymer comprising at least 80%, 85%, 90%, 95%, or 99% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some embodiments, the nucleic acid polymer comprising 100% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some embodiments, the nucleic acid polymer consisting of a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some embodiments, the nucleic acid polymer comprising at least 80%, 85%, 90%, 95%, or 99% sequence identity to a nucleic acid sequence that hybridizes to a target sequence of the truncated TrkB. In some embodiments, the nucleic acid polymer comprising 100% sequence identity to a nucleic acid sequence that hybridizes to a target sequence of the truncated TrkB. In some embodiments, the nucleic acid polymer comprising at least 80%, 85%, 90%, 95%, or 99% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some embodiments, the nucleic acid polymer comprising 100% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some embodiments, the nucleic acid polymer consisting of a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some embodiments, the nucleic acid polymer is further modified at the nucleoside moiety, at the phosphate moiety, or a combination thereof. In some embodiments, the nucleic acid polymer is administered to a patient in need thereof as an intramuscular, intratympanic, intracochlear, intravenous or subcutaneous administration.

Disclosed herein, in certain embodiments, is a method of treating an otic disease or condition, comprising administering to a patient in need thereof a therapeutic amount of a pharmaceutical composition comprising: (a) a vector comprising a nucleic acid polymer wherein the nucleic acid polymer comprises at least 80% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119; and (b) a pharmaceutically acceptable excipient and/or a delivery vehicle. Also disclosed herein, in certain embodiments, is a method of preventing an otic disease or condition or reducing the progression of an otic disease or condition, comprising administering to a patient in need thereof a therapeutic amount of a pharmaceutical composition comprising: (a) a vector comprising a nucleic acid polymer wherein the nucleic acid polymer comprises at least 80% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119; and (b) a pharmaceutically acceptable excipient and/or a delivery vehicle. In some embodiments, the vector comprising a nucleic acid polymer wherein the nucleic acid polymer comprises at least 85%, 90%, 95%, or 99% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some embodiments, the vector comprises a nucleic acid polymer wherein the nucleic acid polymer consists of a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some embodiments, the vector is a viral vector. In some embodiments, the viral vector is a lentiviral vector, a retroviral vector, an adenoviral vector, an adeno-associated viral vector, an alphaviral vector, a herpes simplex virus vector, a vaccinia viral vector, or a chimeric viral vector. In some embodiments, the vector is delivered through a viral delivery method. In some embodiments, the vector is delivered through electroporation, chemical method, microinjection, gene gun, impalefection, hydrodynamics-based delivery, continuous infusion, or sonication. In some embodiments, the chemical method is lipofection. In some embodiments, the vector is administered to a patient in need thereof as an intramuscular, intratympanic, intracochlear, intravenous or subcutaneous administration.

Disclosed herein, in certain embodiments, is a method of treating an otic disease or condition, comprising administering to a patient in need thereof a therapeutic amount of a pharmaceutical composition comprising: (a) a small molecule antagonist of a truncated TrkC or truncated TrkB; and (b) a pharmaceutically acceptable excipient and/or a delivery vehicle. Also disclosed herein, in certain embodiments, is a method of preventing an otic disease or condition or reducing the progression of an otic disease or condition, comprising administering to a patient in need thereof a therapeutic amount of a pharmaceutical composition comprising: (a) a small molecule antagonist of a truncated TrkC or truncated TrkB; and (b) a pharmaceutically acceptable excipient and/or a delivery vehicle. In some embodiments, the small molecule antagonist impedes the truncated TrkC or truncated TrkB interaction with a truncated TrkC or truncated TrkB binding partner. In some embodiments, the small molecule is a peptidomimetic. In some embodiments, the small molecule is a small molecule as illustrated in FIG. 2. In some embodiments, the truncated TrkC is a non-catalytic truncated TrkC. In some embodiments, the truncated TrkC is TrkC.T1. In some embodiments, the truncated TrkB is a non-catalytic truncated TrkB. In some embodiments, the truncated TrkB is TrkB.T1.

Disclosed herein, in certain embodiments, is a method of stratifying an individual having an otic disease or condition for treatment with a pharmaceutical composition, comprising: (a) determining the expression level of a truncated TrkC or truncated TrkB; and (b) administering to the individual a therapeutically effective amount of the pharmaceutical composition, wherein the pharmaceutical composition comprises an antagonist of truncated TrkC or truncated TrkB, wherein the antagonist induces a decrease in the truncated TrkC or truncated TrkB expression level or impedes the truncated TrkC or truncated TrkB interaction with a truncated TrkC or truncated TrkB binding partner; and a pharmaceutically acceptable excipient and/or a delivery vehicle; if there is an elevated expression level of the truncated TrkC or truncated TrkB. Also disclosed herein is a method of optimizing the therapy of an individual receiving a pharmaceutical composition for treatment of an otic disease or condition, comprising: (a) determining the expression level of a truncated TrkC or truncated TrkB; and (b) modifying, discontinuing, or continuing the treatment with the pharmaceutical composition based on the expression level of the truncated TrkC or truncated TrkB, wherein the pharmaceutical composition comprises an antagonist of truncated TrkC or truncated TrkB, wherein the antagonist induces a decrease in the truncated TrkC or truncated TrkB expression level or impedes the truncated TrkC or truncated TrkB interaction with a truncated TrkC or truncated TrkB binding partner; and a pharmaceutically acceptable excipient and/or a delivery vehicle. In some embodiments, the method further comprises testing a sample containing nucleic acid molecules encoding the truncated TrkC or truncated TrkB obtained from the individual. In some embodiments, the nucleic acid molecule is RNA. In some embodiments, the nucleic acid molecule is DNA. In some embodiments, the DNA is genomic DNA. In some embodiments, testing comprises amplifying the nucleic acid molecules encoding the truncated TrkC or truncated TrkB gene. In some embodiments, amplification is by isothermal amplification or polymerase chain reaction (PCR). In some embodiments, amplification is by PCR. In some embodiments, the sample is a cell sample or a tissue sample. In some embodiments, the otic disease or condition comprises a disease or condition associated with hearing loss. In some embodiments, the otic disease or condition comprises ototoxicity, chemotherapy induced hearing loss, excitotoxicity, sensorineural hearing loss, noise induced hearing loss, presbycusis, Meniere's Disease/Syndrome, endolymphatic hydrops, labyrinthitis, Ramsay Hunt's Syndrome, vestibular neuronitis, tinnitus, or microvascular compression syndrome.

Disclosed herein, in certain embodiments, is a method of stratifying an individual having an otic disease or condition for treatment with a pharmaceutical composition, comprising: (a) determining the expression level of a truncated TrkC or truncated TrkB; and (b) administering to the individual a therapeutically effective amount of the pharmaceutical composition, wherein the pharmaceutical composition comprises a nucleic acid polymer that hybridizes to a target sequence of truncated TrkC or truncated TrkB, wherein the nucleic acid polymer is capable of decreasing the expression level of the truncated TrkC or truncated TrkB; and a pharmaceutically acceptable excipient and/or a delivery vehicle; if there is an elevated expression level of the truncated TrkC or truncated TrkB. Also disclosed herein is a method of optimizing the therapy of an individual receiving a pharmaceutical composition for treatment of an otic disease or condition, comprising: (a) determining the expression level of a truncated TrkC or truncated TrkB; and (b) modifying, discontinuing, or continuing the treatment with the pharmaceutical composition based on the expression level of the truncated TrkC or truncated TrkB, wherein the pharmaceutical composition comprises a nucleic acid polymer that hybridizes to a target sequence of truncated TrkC or truncated TrkB, wherein the nucleic acid polymer is capable of decreasing the expression level of the truncated TrkC or truncated TrkB; and a pharmaceutically acceptable excipient and/or a delivery vehicle. Additional described herein is a method of stratifying an individual having an otic disease or condition for treatment with a pharmaceutical composition, comprising: (a) determining the expression level of a truncated TrkC or truncated TrkB; and (b) administering to the individual a therapeutically effective amount of the pharmaceutical composition, wherein the pharmaceutical composition comprises a small molecule antagonist of a truncated TrkC or truncated TrkB; and a pharmaceutically acceptable excipient and/or a delivery vehicle; if there is an elevated expression level of the truncated TrkC or truncated TrkB. Further disclosed herein is a method of optimizing the therapy of an individual receiving a pharmaceutical composition for treatment of an otic disease or condition, comprising: (a) determining the expression level of a truncated TrkC or truncated TrkB; and (b) modifying, discontinuing, or continuing the treatment with the pharmaceutical composition based on the expression level of the truncated TrkC or truncated TrkB, wherein the pharmaceutical composition comprises a small molecule antagonist of a truncated TrkC or truncated TrkB; and a pharmaceutically acceptable excipient and/or a delivery vehicle. In some embodiments, the otic disease or condition comprises a disease or condition associated with hearing loss. In some embodiments, the otic disease or condition comprises ototoxicity, chemotherapy induced hearing loss, excitotoxicity, sensorineural hearing loss, noise induced hearing loss, presbycusis, Meniere's Disease/Syndrome, endolymphatic hydrops, labyrinthitis, Ramsay Hunt's Syndrome, vestibular neuronitis, tinnitus, or microvascular compression syndrome.

Disclosed herein, in certain embodiments, is a method of stratifying an individual having an otic disease or condition for treatment with a pharmaceutical composition, comprising (a) determining the expression level of a truncated TrkC or truncated TrkB; and (b) administering to the individual a therapeutically effective amount of the pharmaceutical composition, wherein the pharmaceutical composition comprises (i) a nucleic acid polymer that hybridizes to a target sequence of truncated TrkC or truncated TrkB, wherein the nucleic acid polymer is capable of decreasing the expression level of the truncated TrkC or truncated TrkB; and (ii) a pharmaceutically acceptable excipient and/or a delivery vehicle; if there is an elevated expression level of the truncated TrkC or truncated TrkB.

Disclosed herein, in certain embodiments, is a method of optimizing the therapy of an individual receiving a pharmaceutical composition for treatment of an otic disease or condition, comprising (a) determining the expression level of a truncated TrkC or truncated TrkB; and (b) modifying, discontinuing, or continuing the treatment with the pharmaceutical composition based on the expression level of the truncated TrkC or truncated TrkB, wherein the pharmaceutical composition comprises (ii) a nucleic acid polymer that hybridizes to a target sequence of truncated TrkC or truncated TrkB, wherein the nucleic acid polymer is capable of decreasing the expression level of the truncated TrkC or truncated TrkB; and (ii) a pharmaceutically acceptable excipient and/or a delivery vehicle.

Disclosed herein, in certain embodiments, is an isolated and purified nucleic acid polymer comprising at least 80%, 85%, 90%, 95%, 99% or 100% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some embodiments, the isolated and purified nucleic acid polymer is further modified at the nucleoside moiety, at the phosphate moiety, or a combination thereof.

Disclosed herein, in certain embodiments, is a pharmaceutical composition comprising an isolated and purified nucleic acid polymer comprising at least 80%, 85%, 90%, 95%, 99% or 100% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119; and a pharmaceutically acceptable excipient and/or a delivery vehicle. In some embodiments, the pharmaceutical composition further comprises a poloxamer. In some embodiments, the pharmaceutical composition has between about 14% to about 21% by weight of the poloxamer. In some embodiments, the pharmaceutical composition has between about 15% to about 17% by weight of the poloxamer. In some embodiments, the poloxamer is poloxamer 407.

BRIEF DESCRIPTION OF THE DRAWINGS

Various aspects of the invention are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the invention are utilized, and the accompanying drawings of which:

FIG. 1A and FIG. 1B illustrate the full length TrkC and TrkB and their respective isoforms. FIG. 1A is adapted from Esteban et al. J Cell Biol 2006; 173:291-299. FIG. 1B is adapted from Luberg et al. J. Neurochem. 2010; 113:952-964.

FIG. 2 illustrates exemplary small molecule antagonists of truncated TrkC. The structures of the exemplary small molecule antagonists are adapted from, for example, Brahimi et al (2014), PlosOne 9:e89617.

FIG. 3 shows a cartoon representation of the anatomy of an ear.

FIG. 4A and FIG. 4B illustrate the level of adenovirus that is detected in perilymph and cochlea following round window membrane administration in the rat.

FIG. 5A and FIG. 5B illustrate the level of lentivirus that is detected in perilymph and cochlea following round window membrane administration in the rat.

FIG. 6 shows reduced expression of TrkC-T1 in cochlea explants following exposure to lentivirus containing shRNA for rat TrkC-T1. TrkC-T1 mRNA was quantified with qPCR and the fold change calculated by the ddCT method.

FIG. 7 shows reduced expression of TrkC-T1 in cochlea explants following exposure to adenovirus containing shRNA for rat TrkC-T1. TrkC-T1 mRNA was quantified with qPCR and the fold change calculated by the ddCT method.

FIG. 8 shows knock-down of TrkC.T1 in heterozygous mice resulting in increased numbers of inner hair cell ribbon synapses at 6 months of age.

DETAILED DESCRIPTION OF THE INVENTION

Neurotrophins are dimeric polypeptide growth factors that regulate the peripheral and central nervous systems and other tissues and promote functions such as neuronal survival and regulation of synaptic plasticity. In some instances, the family of neurotrophins includes nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), and neurotrophin-4 (NT-4). In some instances, neurotrophins mediate their effects through interaction with either the Trk family of receptors or with the p75 neurotrophin receptor which belongs to the tumor necrosis factor receptor superfamily. In some cases, interaction with the Trk family of receptors activates several signaling cascades, such as the phosphatidylinositol-3-kinase, phospholipase C, SN T, and Ras/mitogen-activated protein kinase pathways, which mediate growth and survival responses of the neurotrophins.

The Trk family of receptors comprises three homologs, TrkA (NTRK1), TrkB (NTRK2), and TrkC (NTRK3). Tropomyosin receptor kinase C (TrkC), also known as NT-3 growth factor receptor, neurotrophic tyrosine kinase receptor type 3, or TrkC tyrosine kinase, is the receptor for neurotrophin-3 (NT-3). Tropomyosin receptor kinase B (TrkB), also known as Tyrosine receptor kinase B, BDNF/NT-3 growth factors receptor, or neurotrophic tyrosine kinase receptor type 2, is the receptor for BDNF, NT-4, and in some instances, to NT-3 but at a reduced affinity.

In some embodiments, TrkC and TrkB comprise both full-length and truncated isoforms. In some instances, the truncated isoforms of TrkC and TrkB serve as dominant-negative regulators of their full-length counterparts. In some embodiments, the full-length TrkC and full-length TrkB are associated with neuroprotection. However in some cases, truncated TrkC and TrkB isoforms are associated with neurodegeneration. As such in some embodiments, elevated expression levels or activity of truncated TrkC or truncated TrkB are associated with an otic disease or condition.

Described herein, in certain embodiments, are methods, pharmaceutical compositions, vectors, and kits comprising an antagonist of a truncated TrkC or a truncated TrkB. In some embodiments, described herein is a method of treating an otic disease or condition comprising administering to a patient in need thereof a therapeutic amount of a pharmaceutical composition comprising an antagonist of truncated TrkC or truncated TrkB, wherein the antagonist induces a decrease in the truncated TrkC or truncated TrkB expression level or activity or impedes the truncated TrkC or truncated TrkB interaction with a truncated TrkC or truncated TrkB binding partner. In some embodiments, also described herein include a method of preventing an otic disease or condition or reducing the progression of an otic disease or condition comprising administering to a patient in need thereof a therapeutic amount of a pharmaceutical composition comprising an antagonist of truncated TrkC or truncated TrkB, wherein the antagonist induces a decrease in the truncated TrkC or truncated TrkB expression level or activity or impedes the truncated TrkC or truncated TrkB interaction with a truncated TrkC or truncated TrkB binding partner.

Truncated TrkC and Truncated TrkB Isoforms

In some embodiments, TrkC comprises about 20 exons. In some instances, a truncated TrkC isoform lacks one or more of the 20 exons or comprises one or more altered exons. In some embodiments, a truncated TrkC is a non-catalytic truncated TrkC. In some embodiments, a truncated TrkC protein comprises at least 80%, 85%, 90%, 95%, or 99% sequence identity to the amino acid sequence of SEQ ID NO: 10 or 113. In some instances, a truncated TrkC protein consists of the amino acid sequence of SEQ ID NO: 10 or 113. In some cases, a truncated TrkC is TrkC.T1. In some instances, a truncated TrkC is a truncated TrkC as illustrated in FIG. 1A. In some instances, a full-length TrkC is a TrkC comprising at least 80%, 85%, 90%, 95%, 99% or 100% sequence identity to the amino acid sequence of SEQ ID NOs: 9 and 110-112.

In some instances, TrkB comprises about 24 exons. In some instances, a truncated TrkB isoform lacks one or more of the 24 exons or comprises one or more altered exons. In some instances, truncated TrkB comprises TrkB-T-TK, TrkB-T Shc, TrkB.T1 (or TrkB-T1), TrkB.T2 (or TrkB-T2), TrkB-N, TrkB-N-T-TK, TrkB-N-T-Shc, or TrkB-N-T1. In some embodiments, truncated TrkB is a truncated TrkB as illustrated in FIG. 1B.

In some embodiments, the truncated TrkB is a non-catalytic truncated TrkB. In some instances, a truncated TrkB protein comprises at least 80%, 85%, 90%, 95%, or 99% sequence identity to an amino acid sequence selected from SEQ ID NOs: 11-12 and 121-123. In some cases, a truncated TrkB protein consists of an amino acid sequence selected from SEQ ID NOs: 11-12 and 121-123. In some cases, a truncated TrkB is TrkB.T1 (or TrkB-T1). In some cases, a full-length TrkB is a TrkB comprising at least 80%, 85%, 90%, 95%, 99% or 100% sequence identity to the amino acid sequence of SEQ ID NO: 120.

Nucleic Acid Polymer Antagonists

Disclosed herein, in certain embodiments, is a method of treating an otic disease or condition, preventing an otic disease or condition or reducing the progression of an otic disease or condition comprising administering to a patient in need thereof a therapeutic amount of a pharmaceutical composition which comprises a nucleic acid polymer. In some embodiments, the pharmaceutical composition comprises a nucleic acid polymer that comprises at least 80% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119, and wherein the nucleic acid polymer is at most 100 nucleotides in length; and a pharmaceutically acceptable excipient and/or a delivery vehicle. In some instances, the nucleic acid polymer comprises at least 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some instances, the nucleic acid polymer comprises 100% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some instances, the nucleic acid polymer consists of a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119.

In some cases, the nucleic acid polymer hybridizes to a target sequence of the truncated TrkC or truncated TrkB mRNA. In some cases, the nucleic acid polymer induces a decrease in a truncated TrkC or truncated TrkB expression level. In some cases, the nucleic acid polymer comprising at least 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some cases, the nucleic acid polymer comprising at least 81% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some cases, the nucleic acid polymer comprising at least 82% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some cases, the nucleic acid polymer comprising at least 83% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some cases, the nucleic acid polymer comprising at least 84% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some cases, the nucleic acid polymer comprising at least 85% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some cases, the nucleic acid polymer comprising at least 86% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some cases, the nucleic acid polymer comprising at least 87% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some cases, the nucleic acid polymer comprising at least 88% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some cases, the nucleic acid polymer comprising at least 89% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some cases, the nucleic acid polymer comprising at least 90% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some cases, the nucleic acid polymer comprising at least 91% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some cases, the nucleic acid polymer comprising at least 92% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some cases, the nucleic acid polymer comprising at least 93% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some cases, the nucleic acid polymer comprising at least 94% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some cases, the nucleic acid polymer comprising at least 95% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some cases, the nucleic acid polymer comprising at least 96% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some cases, the nucleic acid polymer comprising at least 97% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some cases, the nucleic acid polymer comprising at least 98% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some cases, the nucleic acid polymer comprising at least 99% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some cases, the nucleic acid polymer comprising 100% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC. In some cases, the nucleic acid polymer consisting of a nucleic acid sequence selected from SEQ ID NOs: 1-5 hybridizes to a target sequence of the truncated TrkC.

In some instances, the nucleic acid polymer comprising at least 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99% sequence identity to a nucleic acid sequence that hybridizes to a target sequence of the truncated TrkB. In some instances, the nucleic acid polymer comprising 100% sequence identity to a nucleic acid sequence that hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer consisting of a nucleic acid sequence that hybridizes to a target sequence of the truncated TrkB.

In some cases, the nucleic acid polymer comprising at least 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer comprising at least 81% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer comprising at least 82% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer comprising at least 83% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer comprising at least 84% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer comprising at least 85% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer comprising at least 86% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer comprising at least 87% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer comprising at least 88% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer comprising at least 89% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer comprising at least 90% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer comprising at least 91% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer comprising at least 92% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer comprising at least 93% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer comprising at least 94% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer comprising at least 95% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer comprising at least 96% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer comprising at least 97% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer comprising at least 98% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer comprising at least 99% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer comprising 100% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB. In some cases, the nucleic acid polymer consisting of a nucleic acid sequence selected from SEQ ID NOs: 114-119 hybridizes to a target sequence of the truncated TrkB.

In some instances, described herein also includes a pharmaceutical composition that comprises a nucleic acid polymer that hybridizes to a target sequence comprising a binding motif selected from CCAAUC, CUCCAA, or ACUGUG, wherein the binding motif is located in a sequence encoding a truncated TrkC. In some instances, the nucleic acid polymer hybridizes to a target sequence that is located at the 3′UTR region of the truncated TrkC mRNA. In some cases, the nucleic acid polymer comprises a short hairpin RNA (shRNA) molecule, a microRNA (miRNA) molecule, a siRNA molecule, or a double stranded RNA molecule. In some cases, the nucleic acid polymer is a shRNA molecule.

In some embodiments, further described herein includes a pharmaceutical composition that comprises a nucleic acid polymer that hybridizes to a target sequence on truncated TrkC or truncated TrkB that is recognized by a microRNA (miRNA). In some instances, the miRNA comprises let-7b-3p (SEQ ID NO: 13), let-7b-5p (SEQ ID NO: 14), miR-1-3p (SEQ ID NO: 15), miR-1-5p (SEQ ID NO: 16), miR-9-3p (SEQ ID NO: 17), miR-9-5p (SEQ ID NO: 18), miR-10a-3p (SEQ ID NO: 19), miR-10a-5p (SEQ ID NO: 20), miR-15a-3p (SEQ ID NO: 21), miR-15a-5p (SEQ ID NO: 22), miR-16-1-3p (SEQ ID NO: 23), miR-16-2-3p (SEQ ID NO: 24), miR-16-5p (SEQ ID NO: 25), miR-17-3p (SEQ ID NO: 26), miR-17-5p (SEQ ID NO: 27), miR-18a-3p (SEQ ID NO: 28), miR-18a-5p (SEQ ID NO: 29), miR-20a-3p (SEQ ID NO: 30), miR-20a-5p (SEQ ID NO: 31), miR-24-3p (SEQ ID NO: 32), miR-24-1-5p (SEQ ID NO: 33), miR-24-2-5p (SEQ ID NO: 34), miR-30e-3p (SEQ ID NO: 35), miR-30e-5p (SEQ ID NO: 36), miR-93-3p (SEQ ID NO: 37), miR-93-5p (SEQ ID NO: 38), miR-103a-3p (SEQ ID NO: 39), miR-103a-2-5p (SEQ ID NO: 40), miR-103b (SEQ ID NO: 41), miR-106a-3p (SEQ ID NO: 42), miR-106a-5p (SEQ ID NO: 43), miR-106b-3p (SEQ ID NO: 44), miR-106b-5p (SEQ ID NO: 45), miR-107 (SEQ ID NO: 46), miR-125a-3p (SEQ ID NO: 47), miR-125a-5p (SEQ ID NO: 48), miR-125b-1-3p (SEQ ID NO: 49), miR-125b-2-3p (SEQ ID NO: 50), miR-125b-5p (SEQ ID NO: 51), miR-128-3p (SEQ ID NO: 52), miR-128-1-5p (SEQ ID NO: 53), miR-128-2-5p (SEQ ID NO: 54), miR-133a-3p (SEQ ID NO: 55), miR-133a-5p (SEQ ID NO: 56), miR-133b (SEQ ID NO: 57), miR-141-3p (SEQ ID NO: 58), miR-141-5p (SEQ ID NO: 59), miR-149-3p (SEQ ID NO: 60), miR-149-5p (SEQ ID NO: 61), miR-182-3p (SEQ ID NO: 62), miR-182-5p (SEQ ID NO: 63), miR-188-3p (SEQ ID NO: 64), miR-188-5p (SEQ ID NO: 65), miR-198 (SEQ ID NO: 66), miR-200a-3p (SEQ ID NO: 67), miR-200a-5p (SEQ ID NO: 68), miR-200b-3p (SEQ ID NO: 69), miR-200b-5p (SEQ ID NO: 70), miR-204-3p (SEQ ID NO: 71), miR-204-5p (SEQ ID NO: 72), miR-206 (SEQ ID NO: 73), miR-221-3p (SEQ ID NO: 74), miR-221-5p (SEQ ID NO: 75), miR-296-3p (SEQ ID NO: 76), miR-296-5p (SEQ ID NO: 77), miR-324-5p (SEQ ID NO: 78), miR-326 (SEQ ID NO: 79), miR-330-3p (SEQ ID NO: 80), miR-331-3p (SEQ ID NO: 81), miR-331-5p (SEQ ID NO: 82), miR-340-3p (SEQ ID NO: 83), miR-340-5p (SEQ ID NO: 84), miR-345-3p (SEQ ID NO: 85), miR-345-5p (SEQ ID NO: 86), miR-374a-3p (SEQ ID NO: 87), miR-374a-5p (SEQ ID NO: 88), miR-374b-3p (SEQ ID NO: 89), miR-374b-5p (SEQ ID NO: 90), miR-374c-3p (SEQ ID NO: 91), miR-374c-5p (SEQ ID NO: 92), miR-384 (SEQ ID NO: 93), miR-412-3p (SEQ ID NO: 94), miR-412-5p (SEQ ID NO: 95), miR-422a (SEQ ID NO: 96), miR-449a (SEQ ID NO: 97), miR-449b-3p (SEQ ID NO: 98), miR-449b-5p (SEQ ID NO: 99), miR-449c-3p (SEQ ID NO: 100), miR-449c-5p (SEQ ID NO: 101), miR-485-3p (SEQ ID NO: 102), miR-509-3p (SEQ ID NO: 103), miR-509-5p (SEQ ID NO: 104), miR-509-3-5p (SEQ ID NO: 105), miR-617 (SEQ ID NO: 106), miR-625-3p (SEQ ID NO: 107), miR-625-5p (SEQ ID NO: 108), miR-765 (SEQ ID NO: 109), miR-768-5p, Hsa-miR-185* or Hsa-miR-491-3p. In some cases, the nucleic acid polymer hybridizes to a target sequence on truncated TrkC or truncated TrkB that is recognized by let-7b-3p (SEQ ID NO: 13), let-7b-5p (SEQ ID NO: 14), miR-1-3p (SEQ ID NO: 15), miR-1-5p (SEQ ID NO: 16), miR-9-3p (SEQ ID NO: 17), miR-9-5p (SEQ ID NO: 18), miR-10a-3p (SEQ ID NO: 19), miR-10a-5p (SEQ ID NO: 20), miR-15a-3p (SEQ ID NO: 21), miR-15a-5p (SEQ ID NO: 22), miR-16-1-3p (SEQ ID NO: 23), miR-16-2-3p (SEQ ID NO: 24), miR-16-5p (SEQ ID NO: 25), miR-17-3p (SEQ ID NO: 26), miR-17-5p (SEQ ID NO: 27), miR-18a-3p (SEQ ID NO: 28), miR-18a-5p (SEQ ID NO: 29), miR-20a-3p (SEQ ID NO: 30), miR-20a-5p (SEQ ID NO: 31), miR-24-3p (SEQ ID NO: 32), miR-24-1-5p (SEQ ID NO: 33), miR-24-2-5p (SEQ ID NO: 34), miR-30e-3p (SEQ ID NO: 35), miR-30e-5p (SEQ ID NO: 36), miR-93-3p (SEQ ID NO: 37), miR-93-5p (SEQ ID NO: 38), miR-103a-3p (SEQ ID NO: 39), miR-103a-2-5p (SEQ ID NO: 40), miR-103b (SEQ ID NO: 41), miR-106a-3p (SEQ ID NO: 42), miR-106a-5p (SEQ ID NO: 43), miR-106b-3p (SEQ ID NO: 44), miR-106b-5p (SEQ ID NO: 45), miR-107 (SEQ ID NO: 46), miR-125a-3p (SEQ ID NO: 47), miR-125a-5p (SEQ ID NO: 48), miR-125b-1-3p (SEQ ID NO: 49), miR-125b-2-3p (SEQ ID NO: 50), miR-125b-5p (SEQ ID NO: 51), miR-128-3p (SEQ ID NO: 52), miR-128-1-5p (SEQ ID NO: 53), miR-128-2-5p (SEQ ID NO: 54), miR-133a-3p (SEQ ID NO: 55), miR-133a-5p (SEQ ID NO: 56), miR-133b (SEQ ID NO: 57), miR-141-3p (SEQ ID NO: 58), miR-141-5p (SEQ ID NO: 59), miR-149-3p (SEQ ID NO: 60), miR-149-5p (SEQ ID NO: 61), miR-182-3p (SEQ ID NO: 62), miR-182-5p (SEQ ID NO: 63), miR-188-3p (SEQ ID NO: 64), miR-188-5p (SEQ ID NO: 65), miR-198 (SEQ ID NO: 66), miR-200a-3p (SEQ ID NO: 67), miR-200a-5p (SEQ ID NO: 68), miR-200b-3p (SEQ ID NO: 69), miR-200b-5p (SEQ ID NO: 70), miR-204-3p (SEQ ID NO: 71), miR-204-5p (SEQ ID NO: 72), miR-206 (SEQ ID NO: 73), miR-221-3p (SEQ ID NO: 74), miR-221-5p (SEQ ID NO: 75), miR-296-3p (SEQ ID NO: 76), miR-296-5p (SEQ ID NO: 77), miR-324-5p (SEQ ID NO: 78), miR-326 (SEQ ID NO: 79), miR-330-3p (SEQ ID NO: 80), miR-331-3p (SEQ ID NO: 81), miR-331-5p (SEQ ID NO: 82), miR-340-3p (SEQ ID NO: 83), miR-340-5p (SEQ ID NO: 84), miR-345-3p (SEQ ID NO: 85), miR-345-5p (SEQ ID NO: 86), miR-374a-3p (SEQ ID NO: 87), miR-374a-5p (SEQ ID NO: 88), miR-374b-3p (SEQ ID NO: 89), miR-374b-5p (SEQ ID NO: 90), miR-374c-3p (SEQ ID NO: 91), miR-374c-5p (SEQ ID NO: 92), miR-384 (SEQ ID NO: 93), miR-412-3p (SEQ ID NO: 94), miR-412-5p (SEQ ID NO: 95), miR-422a (SEQ ID NO: 96), miR-449a (SEQ ID NO: 97), miR-449b-3p (SEQ ID NO: 98), miR-449b-5p (SEQ ID NO: 99), miR-449c-3p (SEQ ID NO: 100), miR-449c-5p (SEQ ID NO: 101), miR-485-3p (SEQ ID NO: 102), miR-509-3p (SEQ ID NO: 103), miR-509-5p (SEQ ID NO: 104), miR-509-3-5p (SEQ ID NO: 105), miR-617 (SEQ ID NO: 106), miR-625-3p (SEQ ID NO: 107), miR-625-5p (SEQ ID NO: 108), miR-765 (SEQ ID NO: 109), miR-768-5p, Hsa-miR-185* or Hsa-miR-491-3p. In some cases, the nucleic acid polymer hybridizes to a target sequence on truncated TrkC or truncated TrkB that is recognized by miR-128-3p (SEQ ID NO: 52), miR-128-1-5p (SEQ ID NO: 53), miR-128-2-5p (SEQ ID NO: 54), miR-509-3p (SEQ ID NO: 103), miR-509-5p (SEQ ID NO: 104), miR-509-3-5p (SEQ ID NO: 105), miR-768-5p, Hsa-miR-185* or Hsa-miR-491-3p. In some cases, the nucleic acid polymer hybridizes to a target sequence on truncated TrkC or truncated TrkB that is recognized by miR-128-3p (SEQ ID NO: 52), miR-128-1-5p (SEQ ID NO: 53), miR-128-2-5p (SEQ ID NO: 54). In some cases, the nucleic acid polymer hybridizes to a target sequence on truncated TrkC or truncated TrkB that is recognized by miR-509-3p (SEQ ID NO: 103), miR-509-5p (SEQ ID NO: 104), miR-509-3-5p (SEQ ID NO: 105). In some cases, the nucleic acid polymer hybridizes to a target sequence on truncated TrkC or truncated TrkB that is recognized by miR-768-5p. In some cases, the nucleic acid polymer hybridizes to a target sequence on truncated TrkC or truncated TrkB that is recognized by Hsa-miR-185*. In some cases, the nucleic acid polymer hybridizes to a target sequence on truncated TrkC or truncated TrkB that is recognized by Hsa-miR-491-3p. In some instances, Hsa-miR-185* and Hsa-miR-491-3p are as described in Maussion, et al., “Regulation of a truncated form of tropomyosin-related kinase B (TrkB) by Hsa-miR-185* in frontal cortex of suicide completers,” PLoS One 7(6): e39301 (2012).

In some embodiments, the nucleic acid polymer is at most 100 nucleotides in length. In some embodiments, the nucleic acid polymer is at most 5, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 40, 45, 50, 55, 60, 70, 80, 90, or 100 nucleotides in length. In some embodiments, the nucleic acid polymer is about 10 nucleotides in length. In some embodiments, the nucleic acid polymer is about 11 nucleotides in length. In some embodiments, the nucleic acid polymer is about 12 nucleotides in length. In some embodiments, the nucleic acid polymer is about 13 nucleotides in length. In some embodiments, the nucleic acid polymer is about 14 nucleotides in length. In some embodiments, the nucleic acid polymer is about 15 nucleotides in length. In some embodiments, the nucleic acid polymer is about 16 nucleotides in length. In some embodiments, the nucleic acid polymer is about 17 nucleotides in length. In some embodiments, the nucleic acid polymer is about 18 nucleotides in length. In some embodiments, the nucleic acid polymer is about 19 nucleotides in length. In some embodiments, the nucleic acid polymer is about 20 nucleotides in length. In some embodiments, the nucleic acid polymer is about 21 nucleotides in length. In some embodiments, the nucleic acid polymer is about 22 nucleotides in length. In some embodiments, the nucleic acid polymer is about 23 nucleotides in length. In some embodiments, the nucleic acid polymer is about 24 nucleotides in length. In some embodiments, the nucleic acid polymer is about 25 nucleotides in length. In some embodiments, the nucleic acid polymer is about 26 nucleotides in length. In some embodiments, the nucleic acid polymer is about 27 nucleotides in length. In some embodiments, the nucleic acid polymer is about 28 nucleotides in length. In some embodiments, the nucleic acid polymer is about 29 nucleotides in length. In some embodiments, the nucleic acid polymer is about 30 nucleotides in length. In some embodiments, the nucleic acid polymer is about 31 nucleotides in length. In some embodiments, the nucleic acid polymer is about 32 nucleotides in length. In some embodiments, the nucleic acid polymer is about 33 nucleotides in length. In some embodiments, the nucleic acid polymer is about 34 nucleotides in length. In some embodiments, the nucleic acid polymer is about 35 nucleotides in length. In some embodiments, the nucleic acid polymer is about 36 nucleotides in length. In some embodiments, the nucleic acid polymer is about 37 nucleotides in length. In some embodiments, the nucleic acid polymer is about 38 nucleotides in length. In some embodiments, the nucleic acid polymer is about 39 nucleotides in length. In some embodiments, the nucleic acid polymer is about 40 nucleotides in length. In some embodiments, the nucleic acid polymer is about 45 nucleotides in length. In some embodiments, the nucleic acid polymer is about 50 nucleotides in length. In some embodiments, the nucleic acid polymer is about 55 nucleotides in length. In some embodiments, the nucleic acid polymer is about 60 nucleotides in length. In some embodiments, the nucleic acid polymer is about 70 nucleotides in length. In some embodiments, the nucleic acid polymer is about 80 nucleotides in length.

In some embodiments, the nucleic acid polymer is between about 10 and about 80 nucleotides in length. In some embodiments, the nucleic acid polymer is between about 10 and about 70 nucleotides in length. In some embodiments, the nucleic acid polymer is between about 10 and about 60 nucleotides in length. In some embodiments, the nucleic acid polymer is between about 10 and about 55 nucleotides in length. In some embodiments, the nucleic acid polymer is between about 10 and about 50 nucleotides in length. In some embodiments, the nucleic acid polymer is between about 10 and about 45 nucleotides in length. In some embodiments, the nucleic acid polymer is between about 10 and about 40 nucleotides in length. In some embodiments, the nucleic acid polymer is between about 10 and about 35 nucleotides in length. In some embodiments, the nucleic acid polymer is between about 10 and about 30 nucleotides in length. In some embodiments, the nucleic acid polymer is between about 10 and about 25 nucleotides in length. In some embodiments, the nucleic acid polymer is between about 10 and about 20 nucleotides in length.

In some embodiments, the nucleic acid polymer comprises a short hairpin RNA (shRNA) molecule, a microRNA (miRNA) molecule, or a siRNA molecule. In some embodiments, the nucleic acid polymer further comprises a complement nucleic acid polymer to form a double stranded RNA molecule.

In some embodiments, the nucleic acid polymer is a shRNA molecule. In some embodiments, the shRNA molecule comprises at least 80% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some instances, the shRNA molecule comprises at least 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some instances, the shRNA molecule comprises at least 85% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some instances, the shRNA molecule comprises at least 90% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some instances, the shRNA molecule comprises at least 91% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some instances, the shRNA molecule comprises at least 92% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some instances, the shRNA molecule comprises at least 93% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some instances, the shRNA molecule comprises at least 94% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some instances, the shRNA molecule comprises at least 95% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some instances, the shRNA molecule comprises at least 96% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some instances, the shRNA molecule comprises at least 97% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some instances, the shRNA molecule comprises at least 98% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some instances, the shRNA molecule comprises at least 99% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some instances, the shRNA molecule comprises 100% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some instances, the shRNA molecule consists of a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119.

In some embodiments, the shRNA molecule hybridizes to a target sequence comprising a binding motif selected from CCAAUC, CUCCAA, or ACUGUG, wherein the binding motif is located in a sequence encoding a truncated TrkC. In some instances, the target sequence is located at the 3′UTR region of the truncated TrkC mRNA.

In some instances, the shRNA molecule is at most 100 nucleotides in length. In some embodiments, the shRNA molecule is at most 5, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 40, 45, 50, 55, 60, 70, 80, 90, or 100 nucleotides in length. In some embodiments, the shRNA molecule is between about 10 and about 80 nucleotides in length. In some embodiments, the shRNA molecule is between about 10 and about 70 nucleotides in length. In some embodiments, the shRNA molecule is between about 10 and about 60 nucleotides in length. In some embodiments, the shRNA molecule is between about 10 and about 55 nucleotides in length. In some embodiments, the shRNA molecule is between about 10 and about 50 nucleotides in length. In some embodiments, the shRNA molecule is between about 10 and about 45 nucleotides in length. In some embodiments, the shRNA molecule is between about 10 and about 40 nucleotides in length. In some embodiments, the shRNA molecule is between about 10 and about 35 nucleotides in length. In some embodiments, the shRNA molecule is between about 10 and about 30 nucleotides in length. In some embodiments, the shRNA molecule is between about 10 and about 25 nucleotides in length. In some embodiments, the shRNA molecule is between about 10 and about 20 nucleotides in length.

In some embodiments, the nucleic acid polymer described herein comprises RNA, DNA or a combination thereof. In some instances, the nucleic acid polymer is a RNA polymer. In some instances, the nucleic acid polymer is further modified at the nucleoside moiety, at the phosphate moiety, or a combination thereof. In some cases, the nucleic acid polymer further comprises one or more artificial nucleotide bases.

In some instances, the one or more artificial nucleotide bases comprises 2′-O-methyl, 2′-O-methoxyethyl (2′-0-MOE), 2′-0-aminopropyl, 2′-deoxy, T-deoxy-2′-fluoro, 2′-O-aminopropyl (2′-O-AP), 2′-O-dimethylaminoethyl (2′-O-DMAOE), 2′-O-dimethylaminopropyl (2′-O-DMAP), T-O-dimethylaminoethyloxyethyl (2′-O-DMAEOE), or 2′-O-N-methylacetamido (2′-O-NMA) modified, locked nucleic acid (LNA), ethylene nucleic acid (ENA), peptide nucleic acid (PNA), l′, 5′-anhydrohexitol nucleic acids (HNA), morpholino, methylphosphonate nucleotides, thiolphosphonate nucleotides, or 2′-fluoro N3-P5′-phosphoramidites.

In some embodiments, the nucleic acid polymer comprises a modification at the nucleoside moiety. In some instances, the modification is at the 2′ hydroxyl group of the ribose moiety. In some instances, the modification is a 2′-O-methyl modification or a 2′-O-methoxyethyl (2′-O-MOE) modification. In some instances, the 2′-O-methyl modification adds a methyl group to the 2′ hydroxyl group of the ribose moiety whereas the 2′O-methoxyethyl modification add a methoxyethyl group to the 2′ hydroxyl group of the ribose moiety. Exemplary chemical structures of a 2′-O-methyl modification of an adenosine molecule and 2′O-methoxyethyl modification of a uridine are illustrated below.

In some embodiments, an additional modification at the 2′ hydroxyl group includes a 2′-O-aminopropyl sugar conformation which involves an extended amine group comprising a propyl linker that binds the amine group to the 2′ oxygen. In some instances, this modification neutralizes the phosphate derived overall negative charge of the oligonucleotide molecule by introducing one positive charge from the amine group per sugar and thereby improve cellular uptake properties due to its zwitterionic properties. An exemplary chemical structure of a 2′-O-aminopropyl nucleoside phosphoramidite is illustrated below.

In some embodiments, the modification at the 2′ hydroxyl group includes a locked or bridged ribose conformation (e.g., locked nucleic acid or LNA) where the 4′ ribose position is also involved. In some embodiments, the oxygen molecule bound at the 2′ carbon is linked to the 4′ carbon by a methylene group, thus forming a 2′-C,4′-C-oxy-methylene-linked bicyclic ribonucleotide monomer. Exemplary representations of the chemical structure of LNA are illustrated below. The representation shown to the left highlights the chemical connectivities of an LNA monomer. The representation shown to the right highlights the locked 3′-endo (³E) conformation of the furanose ring of an LNA monomer.

In some embodiments, a further modification at the 2′ hydroxyl group comprises ethylene nucleic acids (ENA) such as for example 2′-4′-ethylene-bridged nucleic acid, which locks the sugar conformation into a C₃′-endo sugar puckering conformation. In some instances, ENAs are part of the bridged nucleic acids class of modified nucleic acids that also comprises LNA. Exemplary chemical structures of the ENA and bridged nucleic acids are illustrated below.

In some embodiments, still other modifications at the 2′ hydroxyl group include 2′-deoxy, T-deoxy-2′-fluoro, 2′-O-aminopropyl (2′-O-AP), 2′-O-dimethylaminoethyl (2′-O-DMAOE), 2′-O-dimethylaminopropyl (2′-O-DMAP), T-O-dimethylaminoethyloxyethyl (2′-O-DMAEOE), or 2′-O-N-methylacetamido (2′-O-NMA).

In some embodiments, nucleotide analogues further comprise Morpholinos, peptide nucleic acids (PNAs), methylphosphonate nucleotides, thiolphosphonate nucleotides, 2′-fluoro N3-P5′-phosphoramidites, l′, 5′-anhydrohexitol nucleic acids (HNAs), or a combination thereof. In some instances, morpholino or phosphorodiamidate morpholino oligo (PMO) comprises synthetic molecules whose structure mimics natural nucleic acid structure by deviates from the normal sugar and phosphate structures. Instead, the five member ribose ring in some instances is substituted with a six member morpholino ring containing four carbons, one nitrogen and one oxygen. In some cases, the ribose monomers are linked by a phosphordiamidate group instead of a phosphate group. In some cases, these backbone alterations remove all positive and negative charges making morpholinos neutral molecules that cross cellular membranes without the aid of cellular delivery agents such as those used by charged oligonucleotides.

In some embodiments, peptide nucleic acid (PNA) does not contain sugar ring or phosphate linkage. Instead, the bases in some instances are attached and appropriately spaced by oligoglycine-like molecules, therefore, eliminating a backbone charge.

In some embodiments, modification of the phosphate backbone also comprise methyl or thiol modifications such as thiolphosphonate and methylphosphonate nucleotide. Exemplary thiolphosphonate nucleotide (left) and methylphosphonate nucleotide (right) are illustrated below.

Furthermore, exemplary 2′-fluoro N3-P5′-phosphoramidites is illustrated as:

And exemplary hexitol nucleic acid (or l′, 5′-anhydrohexitol nucleic acids (HNA)) is illustrated as:

In some embodiments, also disclosed herein include a vector which comprises a nucleic acid polymer described herein and methods of treatment. In some embodiments, the vector comprises a nucleic acid polymer wherein the nucleic acid polymer comprises at least 80%, 85%, 90%, 95%, or 99% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some instances, the vector comprises a nucleic acid polymer wherein the nucleic acid polymer consists of a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119.

In some instances, the vector is a viral vector. In some instances, the viral vector is a lentiviral vector. In some instances, the viral vector is an adenoviral vector. In some cases, the vector is delivered through a viral delivery method.

In some cases, the vector is delivered through electroporation, chemical method, microinjection, gene gun, impalefection, hydrodynamics-based delivery, continuous infusion, or sonication. In some cases, the chemical method is lipofection. In some cases, the method is infection, or adsorption or transcytosis.

Small Molecule Antagonists

Disclosed herein, in certain embodiments, also includes a method of treating an otic disease or condition, preventing an otic disease or condition or reducing the progression of an otic disease or condition comprising administering to a patient in need thereof a therapeutic amount of a pharmaceutical composition comprising a small molecule antagonists of a truncated TrkC or truncated TrkB; and a pharmaceutically acceptable excipient and/or a delivery vehicle. In some embodiments, the small molecule antagonist impedes the truncated TrkC or truncated TrkB interaction with a truncated TrkC or truncated TrkB binding partner.

In some instances, the small molecule is a peptidomimetic. In some cases, the small molecule is a small molecule as illustrated in FIG. 2. In some embodiments, the small molecule is a small molecule antagonist described in: Brahimi et al., “A peptidomimetic of NT-3 acts as a TrkC antagonist,” Peptides 30(10):1833-1839 (2009); Liu et al., “Bivalent diketopiperazine-based tropomysin receptor kinase C (TrkC) antagonists,” J. Med. Chem. 53(13): 5044-5048 (2010); Bai et al., “In glaucoma the upregulated truncated TrkC.T1 receptor isoform in Glia causes increased TNF-α production, leading to retinal ganglion cell death,” Inv. Ophthalm. & Visual Sci. 51(12): 6639-6651 (2010); or Brahimi et al., “Combinatorial assembly of small molecules into bivalent antagonists of TrkC or TrkA receptors,” PLOS One 9(3): e89617 (2014).

In some embodiments, the small molecule antagonist is a truncated TrkC antagonist. In some embodiments, the truncated TrkC antagonist is a small molecule as illustrated in FIG. 2. In some embodiments, the truncated TrkC antagonists is a small molecule as described in: Brahimi et al., “A peptidomimetic of NT-3 acts as a TrkC antagonist,” Peptides 30(10):1833-1839 (2009); Liu et al., “Bivalent diketopiperazine-based tropomysin receptor kinase C (TrkC) antagonists,” J. Med. Chem. 53(13): 5044-5048 (2010); Bai et al., “In glaucoma the upregulated truncated TrkC.T1 receptor isoform in Glia causes increased TNF-α production, leading to retinal ganglion cell death,” Inv. Ophthalm. & Visual Sci. 51(12): 6639-6651 (2010); or Brahimi et al., “Combinatorial assembly of small molecules into bivalent antagonists of TrkC or TrkA receptors,” PLOS One 9(3): e89617 (2014).

In some instances, the truncated TrkC is a non-catalytic truncated TrkC. As described elsewhere herein, the non-catalytic truncated TrkC protein comprises at least 80%, 85%, 90%, 95%, or 99% sequence identity to the amino acid sequence of SEQ ID NO: 10 or 113. In some instances, the truncated TrkC protein consists of the amino acid sequence of SEQ ID NO: 10 or 113. In some instances, the truncated TrkC is TrkC.T1.

In some embodiments, the truncated TrkB is a non-catalytic truncated TrkB. As described elsewhere herein, the non-catalytic truncated TrkB protein comprises at least 80%, 85%, 90%, 95%, or 99% sequence identity to an amino acid sequence selected from SEQ ID NOs: 11-12 and 121-123. In some instances, the truncated TrkB protein consists of an amino acid sequence selected from SEQ ID NOs: 11-12 and 121-123. In some instances, the truncated TrkB is TrkB.T1.

In some embodiments, the truncated TrkC binding partner comprises a neurotropic factor or a microRNA molecule. In some embodiments, the neurotropic factor is neurotrophin-3(NT-3). In some embodiments, the microRNA molecule comprises miR-128, miR-509, or miR-768-5p. In some embodiments, the truncated TrkB binding partner comprises a neurotropic factor. In some embodiments, the neurotropic factor is brain derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), or neurotrophin-4 (NT-4).

Polypeptide Antagonists

Disclosed herein, in certain embodiments, further includes a method of treating an otic disease or condition, preventing an otic disease or condition or reducing the progression of an otic disease or condition comprising administering to a patient in need thereof a therapeutic amount of a pharmaceutical composition comprising a polypeptide antagonist of a truncated TrkC or truncated TrkB; and a pharmaceutical acceptable excipient and/or a delivery vehicle.

In some embodiments, the polypeptide antagonist is an antibody or binding fragment thereof. In some instances, the antibody or binding fragment thereof comprises a humanized antibody or binding fragment thereof, chimeric antibody or binding fragment thereof, monoclonal antibody or binding fragment thereof, a linear antibody, a single-chain antibody, a bi-specific antibody, a multispecific antibody formed from antibody fragments, a tandem antibody, a veneered antibody, monovalent Fab′, divalent Fab2, single-chain variable fragment (scFv), diabody, minibody, single-domain antibody (sdAb), a rIgG fragment, or camelid antibody or binding fragment thereof.

In some embodiments, the antibody or binding fragment thereof recognizes one or more of the epitopes of the truncated TrkC or truncated TrkB. In some embodiments, the epitopes on the truncated TrkC comprise a region within the ectodomain of the truncated TrkC. In some instances, the ectodomain of the truncated TrkC comprises the leucine-rich repeat regions and the Ig-like domain that is involved in ligand interaction. In some instances, the epitope region within the ectodomain of the truncated TrkC comprises one or more cysteine residues. In some instances, the epitope region within the ectodomain of the truncated TrkC comprises one or more cysteine residues that is capable of forming disulfide bond. In some embodiments, the antibody or binding fragment thereof recognizes one or more of the epitopes that comprises one or more of the cysteine residues.

In some embodiments, the epitopes on the truncated TrkB comprise a region within the ectodomain of the truncated TrkB. In some instances, the ectodomain of the truncated TrkB comprises the leucine-rich repeat regions and the Ig-like domain that is involved in ligand interaction. In some instances, the epitope region within the ectodomain of the truncated TrkB comprises one or more cysteine residues. In some instances, the epitope region within the ectodomain of the truncated TrkB comprises one or more cysteine residues that is capable of forming disulfide bond. In some embodiments, the antibody or binding fragment thereof recognizes one or more of the epitopes that comprises one or more of the cysteine residues.

In some embodiments, the polypeptide antagonist comprises an antibody or binding fragment thereof that recognizes one or more of the epitopes of the truncated TrkC or truncated TrkB. In some instances, the polypeptide antagonist comprises an antibody or binding fragment thereof that recognizes one or more of the epitopes from the ectodomain of either truncated TrkC or truncated TrkB that comprises one or more of the cysteine residues.

In some embodiments, the polypeptide antagonist comprises an antibody or binding fragment thereof that recognizes one or more of the epitopes of the truncated TrkC or truncated TrkB but not one or more of the epitopes of the full-length TrkC or full-length TrkB. In some embodiments, the polypeptide antagonist comprises an antibody or binding fragment thereof that recognizes one or more of the epitopes from the ectodomain of the truncated TrkC or truncated TrkB but not one or more of the epitopes from the ectodomain of the full-length TrkC or full-length TrkB.

In some instances, the truncated TrkC is a non-catalytic truncated TrkC. As described elsewhere herein, the non-catalytic truncated TrkC protein comprises at least 80%, 85%, 90%, 95%, or 99% sequence identity to the amino acid sequence of SEQ ID NO: 10 or 113. In some instances, the truncated TrkC protein consists of the amino acid sequence of SEQ ID NO: 10 or 113. In some instances, the truncated TrkC is TrkC.T1.

In some embodiments, the truncated TrkB is a non-catalytic truncated TrkB. As described elsewhere herein, the non-catalytic truncated TrkB protein comprises at least 80%, 85%, 90%, 95%, or 99% sequence identity to an amino acid sequence selected from SEQ ID NOs: 11-12 and 121-123. In some instances, the truncated TrkB protein consists of an amino acid sequence selected from SEQ ID NOs: 11-12 and 121-123. In some instances, the truncated TrkB is TrkB.T1.

As used herein, the term “antibody” is used in the broadest sense and covers fully assembled antibodies, antibody fragments that bind antigen (e.g., Fab, F(ab′)₂, Fv, single chain antibodies such as single-chain variable fragment (scFv), diabodies, minibodies, single-domain antibodies (sdAbs) or nanobodies, antibody chimeras, hybrid antibodies, bispecific antibodies, humanized antibodies, and the like), and recombinant peptides comprising the forgoing.

As used herein, the terms “monoclonal antibody” and “mAb” as used herein refer to an antibody obtained from a substantially homogeneous population of antibodies, i.e., the individual antibodies comprising the population are identical except for possible naturally occurring mutations that are present in minor amounts.

Native antibodies” and “native immunoglobulins” are usually heterotetrameric glycoproteins of about 150,000 daltons, composed of two identical light (L) chains and two identical heavy (H) chains. Each light chain is linked to a heavy chain by one covalent disulfide bond, while the number of disulfide linkages varies among the heavy chains of different immunoglobulin isotypes. Each heavy and light chain also has regularly spaced intrachain disulfide bridges. Each heavy chain has at one end a variable domain (V_(H)) followed by a number of constant domains. Each light chain has a variable domain at one end (V_(L)) and a constant domain at its other end; the constant domain of the light chain is aligned with the first constant domain of the heavy chain, and the light chain variable domain is aligned with the variable domain of the heavy chain. Particular amino acid residues are believed to form an interface between the light and heavy-chain variable domains.

As used herein, the term “variable” refers to the fact that certain portions of the variable domains differ extensively in sequence among antibodies. Variable regions confer antigen-binding specificity. However, the variability is not evenly distributed throughout the variable domains of antibodies. It is concentrated in three segments called complementarity determining regions (CDRs) or hypervariable regions, both in the light chain and the heavy-chain variable domains. The more highly conserved portions of variable domains are celled in the framework (FR) regions. The variable domains of native heavy and light chains each comprise four FR regions, largely adopting a 13-pleated-sheet configuration, connected by three CDRs, which form loops connecting, and in some cases forming part of, the f3-pleated-sheet structure. The CDRs in each chain are held together in close proximity by the FR regions and, with the CDRs from the other chain, contribute to the formation of the antigen-binding site of antibodies (see, Kabat et al. (1991) NIH PubL. No. 91-3242, Vol. I, pages 647-669). The constant domains are not involved directly in binding an antibody to an antigen, but exhibit various effector functions, such as Fc receptor (FcR) binding, participation of the antibody in antibody-dependent cellular toxicity, initiation of complement dependent cytotoxicity, and mast cell degranulation.

As used herein, the term “hypervariable region,” when used herein, refers to the amino acid residues of an antibody that are responsible for antigen-binding. The hypervariable region comprises amino acid residues from a “complementarily determining region” or “CDR” (i.e., residues 24-34 (L1), 5056 (L2), and 89-97 (L3) in the light-chain variable domain and 31-35 (H1), 50-65 (H2), and 95-102 (H3) in the heavy-chain variable domain; Kabat et al. (1991) Sequences of Proteins of Immunological Interest, 5th Ed. Public Health Service, National Institute of Health, Bethesda, Md.) and/or those residues from a “hypervariable loop” (i.e., residues 26-32 (L1), 50-52 (L2), and 91-96 (L3) in the light-chain variable domain and (H1), 53-55 (H2), and 96-101 (13) in the heavy chain variable domain; Clothia and Lesk, (1987) J. Mol. Biol., 196:901-917). “Framework” or “FR” residues are those variable domain residues other than the hypervariable region residues, as herein deemed.

“Antibody fragments” comprise a portion of an intact antibody. In some embodiments, the portion of an intact antibody is an antigen-binding or variable region of the intact antibody. Examples of antibody fragments include Fab, Fab, F(ab′)2, and Fv fragments; diabodies; linear antibodies (Zapata et al. (1995) Protein Eng. 10:1057-1062); single-chain antibody molecules; and multispecific antibodies formed from antibody fragments. Papain digestion of antibodies produces two identical antigen-binding fragments, called “Fab” fragments, each with a single antigen-binding site, and a residual “Fc” fragment, whose name reflects its ability to crystallize readily. Pepsin treatment yields an F(ab′)2 fragment that has two antigen-combining sites and is still capable of cross-linking antigen.

“Fv” is the minimum antibody fragment that contains a complete antigen recognition and binding site. This region consists of a dimer of one heavy- and one light-chain variable domain in tight, non-covalent association. It is in this configuration that the three CDRs of each variable domain interact to define an antigen-binding site on the surface of the V_(H)-V_(L) dimer. Collectively, the six CDRs confer antigen-binding specificity to the antibody. However, even a single variable domain (or half of an Fv comprising only three CDRs specific for an antigen) has the ability to recognize and bind antigen, although at a lower affinity than the entire binding site.

The Fab fragment also contains the constant domain of the light chain and the first constant domain (C_(H1)) of the heavy chain. Fab fragments differ from Fab′ fragments by the addition of a few residues at the carboxy terminus of the heavy chain CH1 domain including one or more cysteines from the antibody hinge region. Fab′-SH is the designation herein for Fab′ in which the cysteine residue(s) of the constant domains bear a free thiol group. Fab′ fragments are produced by reducing the F(ab′)2 fragment's heavy chain disulfide bridge. Other chemical couplings of antibody fragments are also known.

The “light chains” of antibodies (immunoglobulins) from any vertebrate species assigned to one of two clearly distinct types, called kappa (x) and lambda (X), based on the amino acid sequences of their constant domains.

Depending on the amino acid sequence of the constant domain of their heavy chains, immunoglobulins are assigned to different classes. There are five major classes of human immunoglobulins: IgA, IgD, IgE, IgG, and IgM, and several of these are further divided into subclasses (isotypes), e.g., IgG1, IgG2, IgG3, IgG4, IgA1, and IgA2. The heavy-chain constant domains that correspond to the different classes of immunoglobulins are called alpha, delta, epsilon, gamma, and mu, respectively. The subunit structures and three-dimensional configurations of different classes of immunoglobulins are well known. Different isotypes have different effector functions. For example, human IgG1 and IgG3 isotypes have ADCC (antibody dependent cell-mediated cytotoxicity) activity.

Methods of Antagonist Delivery

In some embodiments, the pharmaceutical composition comprises a vector in which the vector comprises one or more of the nucleic acid polymer described herein or comprise nucleic acid sequence that encodes a polypeptide described herein. In some embodiments, the nucleic acid polymer comprises at least 80%, 85%, 90%, 95%, or 99% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119. In some embodiments, the polypeptide is an antibody or binding fragment thereof. In some embodiments, the antibody or binding fragment thereof comprises a humanized antibody or binding fragment thereof, chimeric antibody or binding fragment thereof, monoclonal antibody or binding fragment thereof, monovalent Fab′, divalent Fab2, single-chain variable fragment (scFv), diabody, minibody, single-domain antibody (sdAb), or camelid antibody or binding fragment thereof. In some embodiments, the vector is a viral vector.

In some embodiments, the viral vector is obtained from any virus, such as a DNA or an RNA virus. In some embodiments, a DNA virus is a single-stranded (ss) DNA virus, a double-stranded (ds) DNA virus, or a DNA virus that contains both ss and ds DNA regions. In some embodiments, an RNA virus is a single-stranded (ss) RNA virus or a double-stranded (ds) RNA virus. In some embodiments, a ssRNA virus is further classified into a positive-sense RNA virus or a negative-sense RNA virus.

In some instances, the viral vector is obtained from a dsDNA virus of the family: Myoviridae, Podoviridae, Siphoviridae, Alloherpesviridae, Herpesviridae, Malacoherpesviridae, Lipothrixviridae, Rudiviridae, Adenoviridae, Ampullaviridae, Ascoviridae, Asfaviridae, Baculoviridae, Bicaudaviridae, Clavaviridae, Corticoviridae, Fuselloviridae, Globuloviridae, Guttaviridae, Hytrosaviridae, Iridoviridae, Marseilleviridae, Mimiviridae, Nimaviridae, Pandoraviridae, Papillomaviridae, Phycodnaviridae, Plasmaviridae, Polydnaviruses, Polyomaviridae, Poxviridae, Sphaerolipoviridae, and Tectiviridae.

In some cases, the viral vector is obtained from a ssDNA virus of the family: Anelloviridae, Bacillariodnaviridae, Bidnaviridae, Circoviridae, Geminiviridae, Inoviridae, Microviridae, Nanoviridae, Parvoviridae, and Spiraviridae.

In some embodiments, the viral vector is obtained from a DNA virus that contains both ss and ds DNA regions. In some cases, the DNA virus is from the group pleolipoviruses. In some cases, the pleolipoviruses include Haloarcula hispanica pleomorphic virus 1, Halogeometricum pleomorphic virus 1, Halorubrum pleomorphic virus 1, Halorubrum pleomorphic virus 2, Halorubrum pleomorphic virus 3, and Halorubrum pleomorphic virus 6.

In some cases, the viral vector is obtained from a dsRNA virus of the family: Birnaviridae, Chrysoviridae, Cystoviridae, Endornaviridae, Hypoviridae, Megavirnaviridae, Partitiviridae, Picobirnaviridae, Reoviridae, Rotavirus and Totiviridae.

In some instances, the viral vector is obtained from a positive-sense ssRNA virus of the family: Alphaflexiviridae, Alphatetraviridae, Alvernaviridae, Arteriviridae, Astroviridae, Barnaviridae, Betaflexiviridae, Bromoviridae, Caliciviridae, Carmotetraviridae, Closteroviridae, Coronaviridae, Dicistroviridae, Flaviviridae, Gammaflexiviridae, Iflaviridae, Leviviridae, Luteoviridae, Marnaviridae, Mesoniviridae, Narnaviridae, Nodaviridae, Permutotetraviridae, Picornaviridae, Potyviridae, Roniviridae, Secoviridae, Togaviridae, Tombusviridae, Tymoviridae, and Virgaviridae.

In some cases, the viral vector is obtained from a negative-sense ssRNA virus of the family: Bornaviridae, Filoviridae, Paramyxoviridae, Rhabdoviridae, Nyamiviridae, Arenaviridae, Bunyaviridae, Ophioviridae, and Orthomyxoviridae.

In some instances, the viral vector is obtained from oncolytic DNA viruses that comprise capsid symmetry that is isocahedral or complex. In some cases, icosahedral oncolytic DNA viruses are naked or comprise an envelope. Exemplary families of oncolytic DNA viruses include the Adenoviridae (for example, Adenovirus, having a genome size of 36-38kb), Herpesviridae (for example, HSV1, having a genome size of 120-200 kb) and Poxviridae (for example, Vaccinia virus and myxoma virus, having a genome size of 130-280 kb).

In some cases, the viral vector is obtained from oncolytic RNA viruses include those having icosahedral or helical capsid symmetry. In some cases, icosahedral oncolytic viruses are naked without envelope and include Reoviridae (for example, Reovirus, having a genome of 22-27 kb) and Picornaviridae (for example, Poliovirus, having a genome size of 7.2-8.4 kb). In other cases, helical oncolytic RNA viruses are enveloped and include Rhabdoviridae (for example, VSV, having genome size of 13-16 kb) and Paramyxoviridae (for example MV and NDV, having genome sizes of 16-20 kb).

Exemplary viral vectors include, but are not limited to, retroviral vectors, lentiviral vectors, adenoviral vectors, adeno-associated viral vectors, alphaviral vectors, herpes simplex virus vectors, vaccinia viral vectors, or chimeric viral vectors. In some embodiments, the viral vector is a lentiviral vector. In some embodiments, the lentiviral vector is pLKO.1 vector.

In some instances, a virus comprising one or more of the nucleic acid polymers or polypeptides described herein are generated using methods well known in the art. In some instances, the methods involve one or more transfection steps and one or more infection steps. In some instances, a cell line such as a mammalian cell line, an insect cell line, or a plant cell line is infected with a virus to produce one or more viruses. Exemplary mammalian cell lines include: 293A cell line, 293FT cell line, 293F cells , 293 H cells, CHO DG44 cells, CHO-S cells, CHO-K1 cells, Expi293F™ cells, Flp-In™ T-REx™ 293 cell line, Flp-In™-293 cell line, Flp-In™-3T3 cell line, Flp-In™-BHK cell line, Flp-In™-CHO cell line, Flp-In™-CV-1 cell line, Flp-In™-Jurkat cell line, FreeStyle™ 293-F cells, FreeStyle™ CHO-S cells, GripTite™ 293 MSR cell line, GS-CHO cell line, HepaRG™ cells, T-REx™ Jurkat cell line, Per.C6 cells, T-REx™ -293 cell line, T-REx™ -CHO cell line, T-REx™-HeLa cell line, 3T6, A549, A9, AtT-20, BALB/3T3, BHK-21, BHL-100, BT, Caco-2, Chang, Clone 9, Clone M-3, COS-1, COS-3, COS-7, CRFK, CV-1, D-17, Daudi, GH1, GH3, H9, HaK, HCT-15, HEp-2, HL-60, HT-1080, HT-29, HUVEC, I-10, IM-9, JEG-2, Jensen, K-562, KB, KG-1, L2, LLC-WRC 256, McCoy, MCF7, VERO, WI-38, WISH, XC, or Y-1. Exemplary insect cell lines include Drosophila S2 cells, Sf9 cells, Sf21 cells, High Five™ cells, or expresSF+® cells. Exemplary plant cell lines include algae cells such as for example Phaeocystis pouchetii.

In some embodiments, the vector comprising one or more of the nucleic acid polymer or polypeptide described herein is delivered through electroporation, chemical method, microinjection, gene gun, impalefection, hydrodynamics-based delivery, continuous infusion, or sonication. In some embodiments, the chemical method is lipofection. In some cases, the method is infection, or adsorption or transcytosis.

In some embodiments, electroporation is a technique in which an electric field is applied to cells to increase the permeability of the cell membrane, allowing for the introduction of chemicals, drugs, or DNA into the cell.

In some embodiments, chemical method is a method of transfection that uses carrier molecules to overcome the cell-membrane barrier. In some instances, the chemical method is lipofection whereby genetic material is injected into a cell using liposomes.

In some embodiments, microinjection is the injection of genetic material into animal cells, tissues or embryos via a needle.

In some embodiments, gene gun is a device that injects cells with genetic information by shooting them with elemental particle of a heavy metal coated with plasmid DNA.

In some embodiments, impalefection is a method of gene delivery using nanomaterials.

In some embodiments, hydrodynamics-based delivery is the rapid injection of a relatively large volume of solution into a blood vessel to enhance the permeability to allow for the delivery of substance into cells. In some instances, the solution contains proteins, oligo nucleotides, DNA, RNA, or small molecules.

In some embodiments, continuous infusion is the uninterrupted administration of drugs, fluids or nutrients into a blood vessel.

In some embodiments, sonication is applying sound energy to agitate particles in a sample for purposes such as but not limited to disrupting or deactivating a biological material or fragmenting molecules of DNA.

In some embodiments, the nucleic acid polymer is delivered as an injection, such as an intramuscular, intratympanic, intracochlear, intravenous or subcutaneous injection, without the need of a viral delivery method or non-viral delivery methods such as electroporation, chemical method, microinjection, gene gun, impalefection, hydrodynamics-based delivery, continuous infusion, or sonication. In some instances, the vector as described above is delivered as an injection, such as an intramuscular, intratympanic, intracochlear, intravenous or subcutaneous injection, without the need of a viral delivery method or non-viral delivery methods such as electroporation, chemical method, microinjection, gene gun, impalefection, hydrodynamics-based delivery, continuous infusion, or sonication.

In some embodiments, the nucleic acid polymer and/or the vector described above further comprises a delivery vehicle. In some instances, the delivery vehicle comprises a lipid-based nanoparticle; a cationic cell penetrating peptide (CPP); or a linear or branched cationic polymer; or a bioconjugate, such as cholesterol, bile acid, lipid, peptide, polymer, protein, or an aptamer, which is conjugated to the nucleic acid polymer or polypeptide described herein for intracellular delivery. In some instances, additional delivery vehicles comprise glycopolymer, carbohydrate polymer, or lipid polymers such as cationic lipids or cationic lipid polymers.

Diseases

Disclosed herein, in certain embodiments, include a method of treating an otic disease or condition associated with an elevated expression level of truncated TrkC or truncated TrkB. In some instances, the method comprises administering to a patient having an otic disease or condition a therapeutic amount of a pharmaceutical composition described herein. In some instances, also described herein include a method of preventing an otic disease or condition or reducing the progression of an otic disease or condition associated with an elevated expression level of truncated TrkC or truncated TrkB. In some instances, the method comprises administering to a patient having an otic disease or condition a therapeutic amount of a pharmaceutical composition described herein.

In some embodiments, the otic diseases or conditions comprise a disease or condition associated with hearing loss. In some instances, the otic disease or condition comprises nystagmus, vertigo, tinnitus, inflammation, infection and/or congestion. In some cases, the otic disease or condition comprises ototoxicity, chemotherapy induced hearing loss, excitotoxicity, sensorineural hearing loss, noise induced hearing loss, presbycusis, Meniere's Disease/Syndrome, endolymphatic hydrops, labyrinthitis, Ramsay Hunt's Syndrome, vestibular neuronitis, tinnitus, or microvascular compression syndrome.

Excitotoxicity

Excitotoxicity refers to the death or damaging of neurons and/or otic hair cells by glutamate and/or similar substances.

Glutamate is the most abundant excitatory neurotransmitter in the central nervous system. Pre-synaptic neurons release glutamate upon stimulation. It flows across the synapse, binds to receptors located on post-synaptic neurons, and activates these neurons. The glutamate receptors include the NMDA, AMPA, and kainate receptors. Glutamate transporters are tasked with removing extracellular glutamate from the synapse. In some instances, certain events (e.g. ischemia or stroke) damage the transporters. This results in excess glutamate accumulating in the synapse. Excess glutamate in synapses results in the over-activation of the glutamate receptors.

The AMPA receptor is activated by the binding of both glutamate and AMPA. Activation of certain isoforms of the AMPA receptor results in the opening of ion channels located in the plasma membrane of the neuron. When the channels open, Na⁺ and Ca²⁺ ions flow into the neuron and K⁺ ions flow out of the neuron.

The NMDA receptor is activated by the binding of both glutamate and NMDA. Activation of the NMDA receptor, results in the opening of ion channels located in the plasma membrane of the neuron. However, these channels are blocked by Mg²⁺ions. Activation of the AMPA receptor results in the expulsion of Mg²⁺ ions from the ion channels into the synapse. When the ion channels open, and the Mg²⁺ ions evacuate the ion channels, Na⁺ and Ca²⁺ ions flow into the neuron, and K⁺ ions flow out of the neuron.

Excitotoxicity occurs when the NMDA receptor and AMPA receptors are over-activated by the binding of excessive amounts of ligands, for example, abnormal amounts of glutamate. The over-activation of these receptors causes excessive opening of the ion channels under their control. This allows abnormally high levels of Ca²⁺ and Na⁺ to enter the neuron. The influx of these levels of Ca²⁺ and Na⁺ into the neuron causes the neuron to fire more often, resulting in a rapid buildup of free radicals and inflammatory compounds within the cell. The free radicals eventually damage the mitochondria, depleting the cell's energy stores. Furthermore, excess levels of Ca²⁺ and Na⁺ ions activate excess levels of enzymes including, but not limited to, phospholipases, endonucleases, and proteases. The over-activation of these enzymes results in damage to the cytoskeleton, plasma membrane, mitochondria, and DNA of the sensory neuron. In some embodiments, an auris sensory cell modulating agent is a glutamate receptor antagonist that reduces or inhibits excessive neuronal firing and/or neuronal cell death. Disclosed herein, in certain embodiments, is a pharmaceutical composition for use in the treatment of a disease of the ear characterized by the dysfunction of an NMDA receptor.

Tinnitus

As used herein, “tinnitus” refers to a disorder characterized by the perception of sound in the absence of any external stimuli. In certain instances, tinnitus occurs in one or both ears, continuously or sporadically, and is most often described as a ringing sound. It is most often used as a diagnostic symptom for other diseases. There are two types of tinnitus: objective and subjective. The former is a sound created in the body which is audible to anyone. The latter is audible only to the affected individual. Studies estimate that over 50 million Americans experience some form of tinnitus. Of those 50 million, about 12 million experience severe tinnitus.

There are several treatments for tinnitus. Lidocaine, administered by IV, reduces or eliminates the noise associated with tinnitus in about 60-80% of sufferers. Selective neurotransmitter reuptake inhibitors, such as nortriptyline, sertraline, and paroxetine, have also demonstrated efficacy against tinnitus. Benzodiazepines are also prescribed to treat tinnitus. In some embodiments, an auris sensory cell modulating agent reduces or inhibits auris sensory cell damage and/or death associated with tinnitus.

Sensorineural Hearing Loss

Sensorineural hearing loss is a type of hearing loss which results from defects (congenital and acquired) in the vestibulocochlear nerve (also known as cranial nerve VIII), or sensory cells of the inner ear. The majority of defects of the inner ear are defects of otic hair cells and sensory neurons.

Aplasia of the cochlea, chromosomal defects, and congenital cholesteatoma are examples of congenital defects which in some instances, result in sensorineural hearing loss. By way of non-limiting example, inflammatory diseases (e.g. suppurative labyrinthitis, meningitis, mumps, measles, viral syphilis, and autoimmune disorders), Meniere's Disease, exposure to ototoxic drugs (e.g. aminoglycosides, loop diuretics, antimetabolites, salicylates, and cisplatin), physical trauma, presbyacusis, and acoustic trauma (prolonged exposure to sound in excess of 90 dB) also results in acquired sensorineural hearing loss.

If the defect resulting in sensorineural hearing loss is a defect in the auditory pathways, the sensorineural hearing loss is called central hearing loss. If the defect resulting in sensorineural hearing loss is a defect in the auditory pathways, the sensorineural hearing loss is called cortical deafness. In some embodiments, an auris sensory cell modulating agent is a trophic agent (e.g., BDNF, GDNF) that promotes growth of auris sensory cells and their processes and connections and reduces or reverses sensorineural hearing loss.

Noise Induced Hearing Loss

Noise induced hearing loss (NIHL) is caused upon exposure to sounds that are too loud or loud sounds that last an extended period of time. Long or repeated or impulse exposure to sounds at or above 85 decibels in some cases cause hearing loss. Hearing loss also occurs from prolonged exposure to loud noises, such as loud music, heavy equipment or machinery, airplanes, gunfire or other human-based noises. NIHL causes damage to the hair cells and/or the auditory nerve. The hair cells are small sensory cells that convert sound energy into electrical signals that travel to the brain. In some instances, impulse sound results in immediate hearing loss that is permanent. This kind of hearing loss in some cases is accompanied by tinnitus—a ringing, buzzing, or roaring in the ears or head—which in some cases subsides over time. Hearing loss and tinnitus in some instances are experienced in one or both ears, and tinnitus continues constantly or occasionally throughout a lifetime. Continuous exposure to loud noise also damages the structure of hair cells, resulting in permanent hearing loss and tinnitus, although the process occurs more gradually than for impulse noise.

In some embodiments, an otoprotectant reverses, reduces or ameliorates NIHL. Examples of otoprotectants that treat or prevent NIHL include, but are not limited to, otoprotectants described herein.

Ototoxicity

Ototoxicity refers to hearing loss caused by a toxin. In some instances, the hearing loss is due to trauma to otic hair cells, the cochlea, and/or the cranial nerve VII. Multiple drugs are known to be ototoxic. Often ototoxicity is dose-dependent. It is permanent or reversible upon withdrawal of the drug.

Known ototoxic drugs include, but are not limited to, the aminoglycoside class of antibiotics (e.g. gentamicin, and amikacin), some members of the macrolide class of antibiotics (e.g erythromycin), some members of the glycopeptide class of antibiotics (e.g. vancomycin), salicylic acid, nicotine, some chemotherapeutic agents (e.g. actinomycin, bleomycin, cisplatin, carboplatin, oxaliplatin and vincristine), and some members of the loop diuretic family of drugs (e.g. furosemide), 6-hydroxy dopamine (6-OH DPAT), 6,7-dinitroquinoxaline-2,3-dione (DNQX) or the like.

Chemotherapeutic agents and the aminoglycoside class of antibiotics induce the production of reactive oxygen species (“ROS”). In some embodiments, ROS damages cells directly by damaging DNA, polypeptides, and/or lipids. Antioxidants prevent damage of ROS by preventing their formation or scavenging free radicals before they damage the cell. Both chemotherapeutic agents and the aminoglycoside class of antibiotics are also thought to damage the ear by binding melanin in the stria vascularis of the inner ear. In some instances, hearing loss induced by chemotherapy agents such as cisplatin, actinomycin, bleomycin, carboplatin, oxaliplatin and vincristine is referred to as chemotherapy induced hearing loss.

Salicylic acid is classified as ototoxic as it inhibits the function of the polypeptide prestin. Prestin mediates outer otic hair cell motility by controlling the exchange of chloride and carbonate across the plasma membrane of outer otic hair cells. It is only found in the outer otic hair cells, not the inner otic hair cells. Accordingly, disclosed herein is the use of controlled release auris-compositions comprising otoprotectants (e.g. antioxidants) to prevent, ameliorate or lessen ototoxic effects of chemotherapy, including but not limited to cisplatin treatment, aminoglycoside or salicylic acid administration, or other ototoxic agents.

Endolymphatic Hydrops

Endolymphatic hydrops refers to an increase in the hydraulic pressure within the endolymphatic system of the inner ear. The endolymph and perilymph are separated by thin membranes which contain multiple nerves. Fluctuation in pressure stresses the membranes and the nerves they house. If the pressure is great enough, disruptions form in these membranes. This results in a mixing of the fluids which leads to a depolarization blockade and transient loss of function. Changes in the rate of vestibular nerve firing often leads to vertigo. Further, the organ of Corti is also be affected. Distortions of the basilar membrane and the inner and outer hair cells leads to hearing loss and/or tinnitus.

Causes include metabolic disturbances, hormonal imbalances, autoimmune disease, and viral, bacterial, or fungal infections. Symptoms include hearing loss, vertigo, tinnitus, and aural fullness. Nystagmus is also present in some instances. Treatment includes systemic administration of benzodiazepine, diuretics (to decrease the fluid pressure), corticosteroids, and/or anti-bacterial, anti-viral, or anti-fungal agents.

Labyrinthitis

Labyrinthitis is an inflammation of the labyrinths of the ear which contain the vestibular system of the inner ear. Causes include bacterial, viral, and fungal infections. In some cases, it is also caused by a head injury or allergies. Symptoms of labyrinthitis include difficulty maintaining balance, dizziness, vertigo, tinnitus, and hearing loss. Recovery takes one to six weeks; however, chronic symptoms are present for years in some cases.

There are several treatments for labyrinthitis. Prochlorperazine is often prescribed as an antiemetic. Serotonin-reuptake inhibitors have been shown to stimulate new neural growth within the inner ear. Additionally, treatment with antibiotics is prescribed if the cause is a bacterial infection, and treatment with corticosteroids and antivirals is recommended if the condition is caused by a viral infection.

Meniere's Disease

Meniere's Disease is an idiopathic condition characterized by sudden attacks of vertigo, nausea and vomiting that in some instances last for 3 to 24 hours, and subside gradually. Progressive hearing loss, tinnitus and a sensation of pressure in the ears accompanies the disease through time. The cause of Meniere's disease is likely related to an imbalance of inner ear fluid homeostasis, including an increase in production or a decrease in reabsorption of inner ear fluid.

Studies of the vasopressin (VP)-mediated aquaporin 2 (AQP2) system in the inner ear suggest a role for VP in inducing endolymph production, thereby increasing pressure in the vestibular and cochlear structures. VP levels were found to be upregulated in endolymphatic hydrops (Meniere's Disease) cases, and chronic administration of VP in guinea pigs was found to induce endolymphatic hydrops. Treatment with VP antagonists, including infusion of OPC-31260 (a competitive antagonist of V2-R) into the scala tympani resulted in a marked reduction of Meniere's disease symptoms. Other VP antagonists include WAY-140288, CL-385004, tolvaptan, conivaptan, SR 121463A and VPA 985. (Sanghi et al. Eur. Heart J. (2005) 26:538-543; Palm et al. Nephrol. Dial Transplant (1999) 14:2559-2562).

Other studies suggest a role for estrogen-related receptor r3/NR3B2 (ERR/Nr3b2) in regulating endolymph production, and therefore pressure in the vestibular/cochlear apparatus. Knock-out studies in mice demonstrate the role of the polypeptide product of the Nr3b2 gene in regulating endolymph fluid production. Nr3b2 expression has been localized in the endolymph-secreting strial marginal cells and vestibular dark cells of the cochlea and vestibular apparatus, respectively. Moreover, conditional knockout of the Nr3b2 gene results in deafness and diminished endolymphatic fluid volume. In some cases, treatment with antagonists to ERR/Nr3b2 assist in reducing endolymphatic volume, and thus alter pressure in the auris interna structures.

Other treatments are aimed at dealing with the immediate symptoms and prevention of recurrence. Low-sodium diets, avoidance of caffeine, alcohol, and tobacco have been advocated. Medications that temporarily relieve vertigo attacks include antihistamines (including meclizine and other antihistamines), and central nervous system agents, including barbiturates and/or benzodiazepines, including lorazepam or diazepam. Other examples of drugs that are useful in relieving symptoms include muscarinic antagonists, including scopolamine. Nausea and vomiting are relieved by suppositories containing antipsychotic agents, including the phenothiazine agent prochlorperazine.

Surgical procedures that have been used to relieve symptoms include the destruction of vestibular and/or cochlear function to relieve vertigo symptoms. These procedures aim to either reduce fluid pressure in the inner ear and/or to destroy inner ear balance function. An endolymphatic shunt procedure, which relieves fluid pressure, are placed in the inner ear to relieve symptoms of vestibular dysfunction. Other treatments include gentamicin application, which when injected into the eardrum destroys sensory hair cell function, thereby eradicating inner ear balance function. Severing of the vestibular nerve are also employed, which while preserving hearing, control vertigo. In some embodiments, an auris sensory cell modulator promotes growth of hair cells and allows a subject to regain inner ear balance function.

Meniere's Syndrome

Meniere's Syndrome, which displays similar symptoms as Meniere's disease, is attributed as a secondary affliction to another disease process, e.g. thyroid disease or inner ear inflammation due to syphilis infection. Meniere's syndrome, thus, are secondary effects to various process that interfere with normal production or resorption of endolymph, including endocrine abnormalities, electrolyte imbalance, autoimmune dysfunction, medications, infections (e.g. parasitic infections) or hyperlipidemia. Treatment of patients afflicted with Meniere's Syndrome is similar to Meniere's Disease.

Ramsay Hunt's Syndrome (Herpes Zoster Infection)

Ramsay Hunt's Syndrome is caused by a herpes zoster infection of the auditory nerve. The infection causes severe ear pain, hearing loss, vertigo, as well as blisters on the outer ear, in the ear canal, as well as on the skin of the face or neck supplied by the nerves. Facial muscles also becomes paralyzed if the facial nerves are compressed by the swelling. Hearing loss is temporary or permanent, with vertigo symptoms usually lasting from several days to weeks.

Treatment of Ramsay Hunt's syndrome includes administration of antiviral agents, including acyclovir. Other antiviral agents include famciclovir and valacyclovir. Combination of antiviral and corticosteroid therapy are also employed to ameliorate herpes zoster infection. Analgesics or narcotics are also administered to relieve the pain, and diazepam or other central nervous system agents to suppress vertigo. Capsaicin, lidocaine patches and nerve blocks are optionally used. Surgery is also performed on compressed facial nerves to relieve facial paralysis.

Microvascular Compression Syndrome

Microvascular compression syndrome (MCS), also called “vascular compression” or “neurovascular compression”, is a disorder characterized by vertigo and tinnitus. It is caused by the irritation of Cranial Nerve VII by a blood vessel. Other symptoms found in subjects with MCS include, but are not limited to, severe motion intolerance, and neuralgic like “quick spins”. MCS is treated with carbamazepine, TRILEPTAL®, and baclofen. In some cases, it is also surgically treated.

Vestibular Neuronitis

Vestibular neuronitis, or vestibular neuropathy, is an acute, sustained dysfunction of the peripheral vestibular system. It is theorized that vestibular neuronitis is caused by a disruption of afferent neuronal input from one or both of the vestibular apparatuses. Sources of this disruption include viral infection and acute localized ischemia of the vestibular nerve and/or labyrinth.

The most significant finding when diagnosing vestibular neuronitis is spontaneous, unidirectional, horizontal nystagmus. It is often accompanied by nausea, vomiting, and vertigo. It is, however, generally not accompanied by hearing loss or other auditory symptoms.

There are several treatments for vestibular neuronitis. Hl-receptor antagonists, such as dimenhydrinate, diphenhydramine, meclizine, and promethazine, diminish vestibular stimulation and depress labyrinthine function through anticholinergic effects. Benzodiazepines, such as diazepam and lorazepam, are also used to inhibit vestibular responses due to their effects on the GABAA receptor. Anticholinergics, for example scopolamine, are also prescribed. They function by suppressing conduction in the vestibular cerebellar pathways. Finally, corticosteroids (i.e. prednisone) are prescribed to ameliorate the inflammation of the vestibular nerve and associated apparatus.

Presbycusis

Age-related hearing loss (presbycusis) is the loss of hearing that gradually occurs with ageing. In some instances, it is one of the most common conditions affecting older and elderly adults. In some cases, approximately one in three people in the United States between the ages of 65 and 74 has hearing loss, and nearly half of those older than 75 have difficulty hearing. In some cases, having trouble hearing makes it hard to understand and follow a doctor's advice, respond to warnings, and hear phones, doorbells, and smoke alarms. Furthermore, in some cases, hearing loss makes it hard to enjoy talking with family and friends, leading to feelings of isolation. In some instances, age-related hearing loss occurs in one or both ears, and sometimes affecting them equally.

In some embodiments, there are many causes of age-related hearing loss. Most commonly, hearing loss arises from changes in the inner ear as one ages, but in some instances, it also results from changes in the middle ear, or from complex changes along the nerve pathways from the ear to the brain. In additional instances, certain medical conditions and medications play a role as well. In some embodiments, presbycusis results from a gradual loss of spiral ganglion neuron afferent fibers and their synapses with hair cells (ribbon synapses), causing a disconnection between the sensory cells that detect sound and the auditory nerve that transmits this information to the auditory brain. Loss of spiral ganglion neurons and hair cells also occurs. Prior exposure to loud noise or other otic insults in some cases exacerbate this ageing process, leading to an accelerated loss of hearing. Presbycusis also involves “hidden hearing loss”, an inability to detect sound against a background noise (“speech-in-noise”) despite a lack of marked changes in hearing thresholds. In some cases, these more subtle decrements in hearing have been associated with a loss of spiral ganglion neuron afferent fibers and their synaptic connections with hair cells (ribbon synapses).

Anatomy of the Ear

As shown in FIG. 3, the outer ear is the external portion of the organ and is composed of the pinna (auricle), the auditory canal (external auditory meatus) and the outward facing portion of the tympanic membrane, also known as the ear drum. The pinna, which is the fleshy part of the external ear that is visible on the side of the head, collects sound waves and directs them toward the auditory canal. Thus, the function of the outer ear, in part, is to collect and direct sound waves towards the tympanic membrane and the middle ear.

The middle ear is an air-filled cavity, called the tympanic cavity, behind the tympanic membrane. The tympanic membrane, also known as the ear drum, is a thin membrane that separates the external ear from the middle ear. The middle ear lies within the temporal bone, and includes within this space the three ear bones (auditory ossicles): the malleus, the incus and the stapes. The auditory ossicles are linked together via tiny ligaments, which form a bridge across the space of the tympanic cavity. The malleus, which is attached to the tympanic membrane at one end, is linked to the incus at its anterior end, which in turn is linked to the stapes. The stapes is attached to the oval window, one of two windows located within the tympanic cavity. A fibrous tissue layer, known as the annular ligament connects the stapes to the oval window. Sound waves from the outer ear first cause the tympanic membrane to vibrate. The vibration is transmitted across to the cochlea through the auditory ossicles and oval window, which transfers the motion to the fluids in the auris interna. Thus, the auditory ossicles are arranged to provide a mechanical linkage between the tympanic membrane and the oval window of the fluid-filled auris interna, where sound is transformed and transduced to the auris interna for further processing. Stiffness, rigidity or loss of movement of the auditory ossicles, tympanic membrane or oval window leads to hearing loss, e.g. otosclerosis, or rigidity of the stapes bone.

The tympanic cavity also connects to the throat via the eustachian tube. The eustachian tube provides the ability to equalize the pressure between the outside air and the middle ear cavity. The round window, a component of the auris interna but which is also accessible within the tympanic cavity, opens into the cochlea of the auris interna. The round window is covered by round window membrane, which consists of three layers: an external or mucous layer, an intermediate or fibrous layer, and an internal membrane, which communicates directly with the cochlear fluid. The round window, therefore, has direct communication with the auris interna via the internal membrane.

Movements in the oval and round window are interconnected, i.e. as the stapes bone transmits movement from the tympanic membrane to the oval window to move inward against the auris interna fluid, the round window (round window membrane) is correspondingly pushed out and away from the cochlear fluid. This movement of the round window allows movement of fluid within the cochlea, which leads in turn to movement of the cochlear inner hair cells, allowing hearing signals to be transduced. Stiffness and rigidity in round window membrane leads to hearing loss because of the lack of ability of movement in the cochlear fluid. Recent studies have focused on implanting mechanical transducers onto the round window, which bypasses the normal conductive pathway through the oval window and provides amplified input into the cochlear chamber.

Auditory signal transduction takes place in the auris interna. The fluid-filled auris interna, or inner ear, consists of two major components: the cochlear and the vestibular apparatus. The auris interna is located in part within the osseous or bony labyrinth, an intricate series of passages in the temporal bone of the skull. The vestibular apparatus is the organ of balance and consists of the three semi-circular canals and the vestibule. The three semi-circular canals are arranged relative to each other such that movement of the head along the three orthogonal planes in space is detected by the movement of the fluid and subsequent signal processing by the sensory organs of the semi-circular canals, called the crista ampullaris. The crista ampullaris contains hair cells and supporting cells, and is covered by a dome-shaped gelatinous mass called the cupula. The hairs of the hair cells are embedded in the cupula. The semi-circular canals detect dynamic equilibrium, the equilibrium of rotational or angular movements.

When the head turns rapidly, the semicircular canals move with the head, but endolymph fluid located in the membranous semi-circular canals tends to remain stationary. The endolymph fluid pushes against the cupula, which tilts to one side. As the cupula tilts, it bends some of the hairs on the hair cells of the crista ampullaris, which triggers a sensory impulse. Because each semicircular canal is located in a different plane, the corresponding crista ampullaris of each semi-circular canal responds differently to the same movement of the head. This creates a mosaic of impulses that are transmitted to the central nervous system on the vestibular branch of the vestibulocochlear nerve. The central nervous system interprets this information and initiates the appropriate responses to maintain balance. Of importance in the central nervous system is the cerebellum, which mediates the sense of balance and equilibrium.

The vestibule is the central portion of the auris interna and contains mechanoreceptors bearing hair cells that ascertain static equilibrium, or the position of the head relative to gravity. Static equilibrium plays a role when the head is motionless or moving in a straight line. The membranous labyrinth in the vestibule is divided into two sac-like structures, the utricle and the saccule. Each structure in turn contains a small structure called a macula, which is responsible for maintenance of static equilibrium. The macula consists of sensory hair cells, which are embedded in a gelatinous mass (similar to the cupula) that covers the macula. Grains of calcium carbonate, called otoliths, are embedded on the surface of the gelatinous layer.

When the head is in an upright position, the hairs are straight along the macula. When the head tilts, the gelatinous mass and otoliths tilts correspondingly, bending some of the hairs on the hair cells of the macula. This bending action initiates a signal impulse to the central nervous system, which travels via the vestibular branch of the vestibulocochlear nerve, which in turn relays motor impulses to the appropriate muscles to maintain balance.

The cochlea is the portion of the auris interna related to hearing. The cochlea is a tapered tube-like structure which is coiled into a shape resembling a snail. The inside of the cochlea is divided into three regions, which is further defined by the position of the vestibular membrane and the basilar membrane. The portion above the vestibular membrane is the scala vestibuli, which extends from the oval window to the apex of the cochlea and contains perilymph fluid, an aqueous liquid low in potassium and high in sodium content. The basilar membrane defines the scala tympani region, which extends from the apex of the cochlea to the round window and also contains perilymph. The basilar membrane contains thousands of stiff fibers, which gradually increase in length from the round window to the apex of the cochlea. The fibers of the basement membrane vibrate when activated by sound. In between the scala vestibuli and the scala tympani is the cochlear duct, which ends as a closed sac at the apex of the cochlea. The cochlear duct contains endolymph fluid, which is similar to cerebrospinal fluid and is high in potassium.

The organ of Corti, the sensory organ for hearing, is located on the basilar membrane and extends upward into the cochlear duct. The organ of Corti contains hair cells, which have hairlike projections that extend from their free surface, and contacts a gelatinous surface called the tectorial membrane. Although hair cells have no axons, they are surrounded by sensory nerve fibers that form the cochlear branch of the vestibulocochlear nerve (cranial nerve VIII).

As discussed, the oval window, also known as the elliptical window communicates with the stapes to relay sound waves that vibrate from the tympanic membrane. Vibrations transferred to the oval window increases pressure inside the fluid-filled cochlea via the perilymph and scala vestibuli/scala tympani, which in turn causes the round window membrane to expand in response. The concerted inward pressing of the oval window/outward expansion of the round window allows for the movement of fluid within the cochlea without a change of intra-cochlear pressure. However, as vibrations travel through the perilymph in the scala vestibuli, they create corresponding oscillations in the vestibular membrane. These corresponding oscillations travel through the endolymph of the cochlear duct, and transfer to the basilar membrane. When the basilar membrane oscillates, or moves up and down, the organ of Corti moves along with it. The hair cell receptors in the Organ of Corti then move against the tectorial membrane, causing a mechanical deformation in the tectorial membrane. This mechanical deformation initiates the nerve impulse which travels via the vestibulocochlear nerve to the central nervous system, mechanically transmitting the sound wave received into signals that are subsequently processed by the central nervous system.

Combination Therapy

In some embodiments, a pharmaceutical composition described herein is administered in combination with an additional therapeutic agent. In some instances, the additional therapeutic agent includes but is not limited to, anti-emetic agents, antimicrobial agents, antioxidants, anti-septic agents or the like.

Anti-Emetic Agents

Anti-Emetic agents are optionally used in combination with the pharmaceutical compositions or formulations disclosed herein. Anti-emetic agents include promethazine, prochlorperazine, trimethobenzamide, and triethylperazine. Other anti-emetic agents include 5HT3 antagonists such as dolasetron, granisetron, ondansetron, tropisetron, and palonosetron; and neuroleptics such as droperidol. Further anti-emetic agents include antihistamines, such as meclizine; phenothiazines such as perphenazine, and thiethyl perazine; dopamine antagonists, including domperidone, properidol, haloperidol, chlorpromazine, promethazine, prochlorperazine, metoclopramide and combinations thereof; cannabinoids, including dronabinol, nabilone, sativex, and combinations thereof; anticholinergics, including scopolamine; and steroids, including dexamethasone; trimethobenzamine, emetrol, propofol, muscimol, and combinations thereof.

Antimicrobial Agents

Antimicrobial agents are also contemplated as useful with the pharmaceutical compositions or formulations disclosed herein. Antimicrobial agents include agents that act to inhibit or eradicate microbes, including bacteria, fungi or parasites. In some cases, specific antimicrobial agents are used to combat specific microbes. Accordingly, a skilled practitioner knows which antimicrobial agent is relevant or useful depending on the microbe identified, or the symptoms displayed. Antimicrobial agents include antibiotics, antiviral agents, antifungal agents, and antiparasitic agents.

Exemplary antibiotics include amikacin, gentamicin, kanamycin, neomycin, netilmicin, streptomycin, tobramycin, paromomycin, geldanmycin, herbimycin, loracarbef, ertapenem, doripenem, imipenem, cilastatin, meropenem, cefadroxil, cefazolin, cefalotin, cefalexin, cefaclor, cefamandole, cefoxitin, defprozil, cefuroxime, cefixime, cefdinir, cefditoren, cefoperazone, cefotaxime, cefpodoxime, ceftazidime, ceftibuten, ceftizoxime, ceftriaxone, cefepime, ceftobiprole, teicoplanin, vancomycin, azithromycin, clarithromycin, dirithromycin, erythromycin, roxithromycin, troleandomycin, telithromycin, spectinomycin, aztreonam, amoxicillin, ampicillin, azlocillin, carbenicillin, cloxacillin, dicloxacillin, flucloxacillin, mezlocillin, meticillin, nafcillin, oxacillin, penicillin, piperacillin, ticarcillan, bacitracin, colistin, polymyxin B, ciprofloxacin, enoxacin, gatifloxacin, levofloxacin, lomefloxacin, moxifloxacin, norfloxacin, ofloxacin, trovfloxacin, mafenide, pronto sil, sulfacetamide, sulfamethizole, sulfanimilimde, sulfsalazine, sulfsioxazole, trimethoprim, demeclocycline, doxycycline, minocycline, oxtetracycline, tetracycline, arsphenamine, chloramphenicol, clindamycin, lincomycin, ethambutol, fosfomycin, fusidic acid, furazolidone, isoniazid, linezolid, metronidazole, mupirocin, nitrofurantoin, platensimycin, pyrazinamide, quinuspristin/dalfopristin, rifampin, tinidazole, and combinations thereof.

Exemplary antiviral agents include acyclovir, famciclovir and valacyclovir. Other antiviral agents include abacavir, aciclovir, adfovir, amantadine, amprenavir, arbidol., atazanavir, artipla, brivudine, cidofovir, combivir, edoxudine, efavirenz, emtricitabine, enfuvirtide, entecavir, fomvirsen, fosamprenavir, foscarnet, fosfonet, ganciclovir, gardasil, ibacitabine, imunovir, idoxuridine, imiquimod, indinavir, inosine, integrase inhibitors, interferons, including interferon type III, interferon type II, interferon type I, lamivudine, lopinavir, loviride, MK-0518, maraviroc, moroxydine, nelfinavir, nevirapine, nexavir, nucleoside analogues, oseltamivir, penciclovir, peramivir, pleconaril, podophyllotoxin, protease inhibitors, reverse transcriptase inhibitors, ribavirin, rimantadine, ritonavir, saquinavir, stavudine, tenofovir, tenofovir disoproxil, tipranavir, trifluridine, trizivir, tromantadine, truvada, valganciclovir, vicriviroc, vidarabine, viramidine, zalcitabine, zanamivir, zidovudine, and combinations thereof.

Exemplary antifungal agents include amrolfine, utenafine, naftifine, terbinafine, flucytosine, fluconazole, itraconazole, ketoconazole, posaconazole, ravuconazole, voriconazole, clotrimazole, econazole, miconazole, oxiconazole, sulconazole, terconazole, tioconazole, nikkomycin Z, caspofungin, micafungin, anidulafungin, amphotericin B, liposomal nystastin, pimaricin, griseofulvin, ciclopirox olamine, haloprogin, tolnaftate, undecylenate, and combinations thereof. Exemplary antiparasitic agents include amitraz, amoscanate, avermectin, carbadox, diethylcarbamizine, dimetridazole, diminazene, ivermectin, macrofilaricide, malathion, mitaban, oxamniquine, permethrin, praziquantel, prantel pamoate, selamectin, sodium stibogluconate, thiabendazole, and combinations thereof.

Antioxidants

Antioxidants are optionally used in combination with the pharmaceutical compositions described herein. Antioxidants include agents such as those that modulate the degeneration of neurons and/or hair cells of the auris. Accordingly, some embodiments incorporate the use of antioxidants. In some embodiments, the antioxidant is vitamin C, N-acetylcysteine, vitamin E, Ebselen (2-phenyl-1, 2-benzisoselenazol-3(2H)-one (also called PZ 51 or DR3305), L-methionine, Idebenone (2-(10-hydroxydecyl)-5,6-dimethoxy-3-methyl-cyclohexa-2,5-diene-1,4-dione). In some embodiments, antioxidants are trophic agents and promote growth of healthy cells.

Anti-Septic Agents

Anti-septic agents are optionally used in combination with the compositions described herein. Anti-septic agents are also contemplated as useful with the formulations disclosed herein. Anti-septic agents include, but are not limited to, acetic acid, boric acid, gentian violet, hydrogen peroxide, carbamide peroxide, chlorhexidine, saline, mercurochrome, povidone iodine, polyhyroxine iodine, cresylate and aluminum acetate, and mixtures thereof.

Other agents are optionally used in any composition or device described herein. In some embodiments, a monoamine oxidase inhibitor (e.g., Rasagiline, R(+)-N-propargyl-1-aminoindan) is used in any composition or device described herein. In some embodiments, an adenosine antagonist (e.g., R-N6-Phenylisopropyl adenosine, 1-2-oxothiazolidine-4-carboxylic acid (Procysteine)) is used in any composition or device described herein. Any combination of active agents and/or second therapeutic agent is compatible with the compositions described herein.

Otic Surgery and Implants

In some embodiments, the pharmaceutical formulations or compositions described herein are used in combination with (e.g., implantation, short-term use, long-term use, or removal of) implants (e.g., cochlear implants). As used herein, implants include auris-interna or auris-media medical devices, examples of which include cochlear implants, hearing sparing devices, hearing-improvement devices, short electrodes, micro-prostheses or piston-like prostheses; needles; stem cell transplants; drug delivery devices; any cell-based therapeutic; or the like. In some instances, the implants are used in conjunction with a patient experiencing hearing loss. In some instances, the hearing loss is present at birth. In some instances, the hearing loss is associated with conditions such as AIED, bacterial meningitis or the like that lead to osteoneogenesis and/or nerve damage with rapid obliteration of cochlear structures and profound hearing loss.

In some instances, an implant is an immune cell or a stem cell transplant in the ear. In some instances, an implant is a small electronic device that has an external portion placed behind the ear, and a second portion that is surgically placed under the skin that helps provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing. By way of example, such cochlear medical device implants bypass damaged portions of the ear and directly stimulate the auditory nerve. In some instances, cochlear implants are used in single sided deafness. In some instances, cochlear implants are used for deafness in both ears.

In some embodiments, administration of an auris sensory cell modulator composition or device described herein in combination with an otic intervention (e.g., an intratympanic injection, a stapedectomy, a medical device implant or a cell-based transplant) delays or prevents collateral damage to auris structures, e.g., irritation, cell damage, cell death, osteoneogeneis and/or further neuronal degeneration, caused by the external otic intervention (e.g., installation of an external device and/or cells in the ear). In some embodiments, administration of an auris sensory cell modulator composition or device described herein in combination with an implant allows for a more effective restoration of hearing loss compared to an implant alone.

In some embodiments, administration of an auris sensory cell modulator composition or device described herein reduces damage to cochlear structures caused by underlying conditions (e.g., bacterial meningitis, autoimmune ear disease (AIED)) allowing for successful cochlear device implantation. In some embodiments, administration of a composition or device described herein, in conjunction with otic surgery, medical device implantation and/or cell transplantation, reduces or prevents cell damage and/or death (e.g., auris sensory hair cell death and/or damage) associated with otic surgery, medical device implantation and/or cell transplantation.

In some embodiments, administration of an auris sensory cell modulator composition or device described herein (e.g., a composition or device comprising a growth factor) in conjunction with a cochlear implant or stem cell transplant has a trophic effect (e.g., promotes healthy growth of cells and/or healing of tissue in the area of an implant or transplant). In some embodiments, a trophic effect is desirable during otic surgery or during intratympanic injection procedures. In some embodiments, a trophic effect is desirable after installation of a medical device or after a cell transplant. In some of such embodiments, the auris sensory cell modulator compositions or devices described herein are administered via direct cochlear injection, through a chochleostomy or via deposition on the round window.

In some embodiments, administration of an anti-inflammatory or immunosuppressant composition (e.g., a composition comprising an immunosuppresant such as a corticosteroid) reduces inflammation and/or infections associated with otic surgery, implantation of a medical device or a cell transplant. In some instances, perfusion of a surgical area with an auris sensory cell modulator formulation described herein reduces or eliminates post-surgical and/or post-implantation complications (e.g., inflammation, hair cell damage, neuronal degeneration, osteoneogenesis or the like). In some instances, perfusion of a surgical area with a formulation described herein reduces post-surgery or post-implantation recuperation time. In some embodiments, a medical device is coated with a composition described herein prior to implantation in the ear.

In one aspect, the formulations described herein, and modes of administration thereof, are applicable to methods of direct perfusion of the inner ear compartments. Thus, the formulations described herein are useful in combination with otic interventions. In some embodiments, an otic intervention is an implantation procedure (e.g., implantation of a hearing device in the cochlea). In some embodiments, an otic intervention is a surgical procedure including, by way of non-limiting examples, cochleostomy, labyrinthotomy, mastoidectomy, stapedectomy, stapedotomy, endolymphatic sacculotomy, tympanostomy or the like. In some embodiments, the inner ear compartments are perfused with a formulation described herein prior to otic intervention, during otic intervention, or after otic intervention, or a combination thereof.

In some embodiments, when perfusion is carried out in combination with otic intervention, the auris sensory cell compositions are immediate release compositions. In some of such embodiments, the immediate release formulations described herein are non-thickened compositions and are substantially free of extended release components (e.g., gelling components such as polyoxyethylene-polyoxypropylene copolymers). In some of such embodiments, the compositions contain less than 5% of the extended release components (e.g., gelling components such as polyoxyethylene-polyoxypropylene triblock copolymers) by weight of the formulation. In some of such embodiments, the compositions contain less than 2% of the extended release components (e.g., gelling components such as polyoxyethylene-polyoxypropylene triblock copolymers) by weight of the formulation. In some of such embodiments, the compositions contain less than 1% of the extended release components (e.g., gelling components such as polyoxyethylene-polyoxypropylene triblock copolymers) by weight of the formulation. In some of such embodiments, a composition described herein that is used for perfusion of a surgical area contains substantially no gelling component and is an immediate release composition.

Pharmaceutical Composition/Formulations

In some embodiments, pharmaceutical compositions or formulations described herein are administered to a subject by multiple administration routes, including but not limited to, parenteral (e.g., intratympanic, intracochlear, intravenous, subcutaneous, intramuscular), oral, intranasal, buccal, topical, rectal, or transdermal administration routes. In some instances, the pharmaceutical composition describe herein is formulated for parenteral (e.g., intratympanic, intracochlear, intravenous, subcutaneous, intramuscular) administration. In other instances, the pharmaceutical composition describe herein is formulated for oral administration. In still other instances, the pharmaceutical composition describe herein is formulated for intranasal administration.

In some embodiments, a pharmaceutical composition or formulation described herein comprises between about 0.001% —about 60% of an active ingredient by weight of the composition or formulation. In some instances, a pharmaceutical composition or formulation described herein comprises between about 0.01% -about 20%, between about 0.01% -about 10%, between about 0.01% -about 7.5%, between about 0.01% -6%, between about 0.01-5%, between about 0.1-about 10%, or between about 0.1-about 6% of an active ingredient by weight of the composition or formulation.

In some embodiments, a pharmaceutical composition or formulation described herein comprises an antagonist of truncated TrkC or truncated TrkB. In some cases, a pharmaceutical composition or formulation described herein comprises between about 0.001% -about 60% of an antagonist of truncated TrkC or truncated TrkB by weight of the composition or formulation. In some instances, a pharmaceutical composition or formulation described herein comprises between about 0.01% -about 20%, between about 0.01% -about 10%, between about 0.01% -about 7.5%, between about 0.01%-6%, between about 0.01-5%, between about 0.1-about 10%, or between about 0.1-about 6% of an antagonist of truncated TrkC or truncated TrkB by weight of the composition or formulation.

In some embodiments, pharmaceutical compositions or formulation described herein include, but are not limited to, aqueous liquid dispersions, self-emulsifying dispersions, solid solutions, liposomal dispersions, aerosols, solid dosage forms, powders, immediate release formulations, controlled release formulations, fast melt formulations, tablets, capsules, pills, delayed release formulations, extended release formulations, pulsatile release formulations, multiparticulate formulations, and mixed immediate and controlled release formulations.

In some embodiments, pharmaceutical compositions or formulations described herein include a carrier or carrier materials which include any commonly used excipients in pharmaceutics and are selected on the basis of compatibility with the composition disclosed herein, and the release profile properties of the desired dosage form. Exemplary carrier materials include, e.g., binders, suspending agents, disintegration agents, filling agents, surfactants, solubilizers, stabilizers, lubricants, wetting agents, diluents, and the like. Pharmaceutically compatible carrier materials include, but are not limited to, acacia, gelatin, colloidal silicon dioxide, calcium glycerophosphate, calcium lactate, maltodextrin, glycerine, magnesium silicate, polyvinylpyrrollidone (PVP), cholesterol, cholesterol esters, sodium caseinate, soy lecithin, taurocholic acid, phosphotidylcholine, sodium chloride, tricalcium phosphate, dipotassium phosphate, cellulose and cellulose conjugates, sugars sodium stearoyl lactylate, carrageenan, monoglyceride, diglyceride, pregelatinized starch, and the like. See, e.g., Remington: The Science and Practice of Pharmacy, Nineteenth Ed (Easton, Pa.: Mack Publishing Company, 1995); Hoover, John E., Remington's Pharmaceutical Sciences, Mack Publishing Co., Easton, Pa. 1975; Liberman, H. A. and Lachman, L., Eds., Pharmaceutical Dosage Forms, Marcel Decker, New York, N.Y., 1980; and Pharmaceutical Dosage Forms and Drug Delivery Systems, Seventh Ed. (Lippincott Williams & Wilkins1999).

In some embodiments, pharmaceutical compositions or formulations include dispersing agents, and/or viscosity modulating agents which include materials that control the diffusion and homogeneity of a drug through liquid media or a granulation method or blend method. In some embodiments, these agents also facilitate the effectiveness of a coating or eroding matrix. Exemplary diffusion facilitators/dispersing agents include, e.g., hydrophilic polymers, electrolytes, Tween® 60 or 80, PEG, polyvinylpyrrolidone (PVP; commercially known as Plasdone®), and the carbohydrate-based dispersing agents such as, for example, hydroxypropyl celluloses (e.g., HPC, HPC-SL, and HPC-L), hydroxypropyl methylcelluloses (e.g., HPMC K100, HPMC K4M, HPMC K15M, and HPMC KlOOM), carboxymethylcellulose sodium, methylcellulose, hydroxyethylcellulo se, hydroxypropylcellulo se, hydroxypropylmethylcellulose phthalate, hydroxypropylmethylcellulo se acetate stearate (HPMCAS), noncrystalline cellulose, magnesium aluminum silicate, triethanolamine, polyvinyl alcohol (PVA), vinyl pyrrolidone/vinyl acetate copolymer (S630), 4-(1,1,3,3-tetramethylbutyl)-phenolpolymer with ethylene oxide and formaldehyde (also known as tyloxapol), poloxamers (e.g., Pluronics F68®, F88®, F108®, or F127® (poloxamer 407), which are block copolymers of ethylene oxide and propylene oxide); and poloxamines (e.g., Tetronic 908®, also known as Poloxamine 908®, which is a tetrafunctional block copolymer derived from sequential addition of propylene oxide and ethylene oxide to ethylenediamine (BASF Corporation, Parsippany, N.J.)), polyvinylpyrrolidone K12, polyvinylpyrrolidone K17, polyvinylpyrrolidone K25, or polyvinylpyrrolidone K30, polyvinylpyrrolidone/vinyl acetate copolymer (S-630), polyethylene glycol, e.g., the polyethylene glycol has a molecular weight of about 300 to about 6000, or about 3350 to about 4000, or about 7000 to about 5400, sodium carboxymethylcellulose, methylcellulose, polysorbate-80, sodium alginate, gums, such as, e.g., gum tragacanth and gum acacia, guar gum, xanthans, including xanthan gum, sugars, cellulosics, such as, e.g., sodium carboxymethylcellulose, methylcellulose, sodium carboxymethylcellulose, polysorbate-80, sodium alginate, polyethoxylated sorbitan monolaurate, polyethoxylated sorbitan monolaurate, povidone, carbomers, polyvinyl alcohol (PVA), alginates, chitosans and combinations thereof. Plasticizers such as cellulose or triethyl cellulose are also used as dispersing agents. Dispersing agents particularly useful in liposomal dispersions and self-emulsifying dispersions are dimyristoyl phosphatidyl choline, natural phosphatidyl choline from eggs, natural phosphatidyl glycerol from eggs, cholesterol and isopropyl myristate.

In some embodiments, pharmaceutical compositions or formulations comprise a poloxamer (e.g., Pluronics F68®, F88®, F108®, or F127® (poloxamer 407)). In some instances, pharmaceutical compositions or formulations comprise between about 14% to about 21% by weight of the poloxamer. In some instances, pharmaceutical compositions or formulations comprise between about 15% to about 17% by weight of the poloxamer. In some instances, pharmaceutical compositions or formulations comprise about 14% by weight of the poloxamer. In some instances, pharmaceutical compositions or formulations comprise about 15% by weight of the poloxamer. In some instances, pharmaceutical compositions or formulations comprise about 16% by weight of the poloxamer. In some instances, pharmaceutical compositions or formulations comprise about 17% by weight of the poloxamer. In some instances, pharmaceutical compositions or formulations comprise about 18% by weight of the poloxamer. In some instances, pharmaceutical compositions or formulations comprise about 19% by weight of the poloxamer. In some instances, pharmaceutical compositions or formulations comprise about 20% by weight of the poloxamer. In some instances, pharmaceutical compositions or formulations comprise about 21% by weight of the poloxamer.

In some instances, pharmaceutical compositions or formulations comprise poloxamer 407 (F127®). In some instances, pharmaceutical compositions or formulations comprise between about 14% to about 21% by weight of poloxamer 407 (F127®). In some instances, pharmaceutical compositions or formulations comprise between about 15% to about 17% by weight of poloxamer 407 (F127®). In some instances, pharmaceutical compositions or formulations comprise about 14% by weight of poloxamer 407 (F127®). In some instances, pharmaceutical compositions or formulations comprise about 15% by weight of poloxamer 407 (F127®). In some instances, pharmaceutical compositions or formulations comprise about 16% by weight of poloxamer 407 (F127®). In some instances, pharmaceutical compositions or formulations comprise about 17% by weight of poloxamer 407 (F127®). In some instances, pharmaceutical compositions or formulations comprise about 18% by weight of poloxamer 407 (F127®). In some instances, pharmaceutical compositions or formulations comprise about 19% by weight of poloxamer 407 (F127®). In some instances, pharmaceutical compositions or formulations comprise about 20% by weight of poloxamer 407 (F127®). In some instances, pharmaceutical compositions or formulations comprise about 21% by weight of poloxamer 407 (F127®).

In some embodiments, pharmaceutical compositions or formulations include pH adjusting agents or buffering agents which include acids such as acetic, boric, citric, lactic, phosphoric and hydrochloric acids; bases such as sodium hydroxide, sodium phosphate, sodium borate, sodium citrate, sodium acetate, sodium lactate and tris-hydroxymethylaminomethane; and buffers such as citrate/dextrose, sodium bicarbonate and ammonium chloride. Such acids, bases and buffers are included in an amount required to maintain pH of the composition in an acceptable range.

In some embodiments, pharmaceutical compositions or formulations also include one or more salts in an amount required to bring osmolality of the composition into an acceptable range. Such salts include those such as having sodium, potassium or ammonium cations and chloride, citrate, ascorbate, borate, phosphate, bicarbonate, sulfate, thio sulfate or bisulfite anions; suitable salts include sodium chloride, potassium chloride, sodium thio sulfate, sodium bisulfite and ammonium sulfate.

In some embodiments, pharmaceutical compositions or formulations further include diluent which are also used to stabilize compounds because they provide a more stable environment. Salts dissolved in buffered solutions (which also provide pH control or maintenance) are utilized as diluents in the art, including, but are not limited to a phosphate buffered saline solution. In certain instances, diluents increase bulk of the composition to facilitate compression or create sufficient bulk for homogenous blend for capsule filling. Such compounds include e.g., lactose, starch, mannitol, sorbitol, dextrose, microcrystalline cellulose such as Avicel®; dibasic calcium phosphate, dicalcium phosphate dihydrate; tricalcium phosphate, calcium phosphate; anhydrous lactose, spray-dried lactose; pregelatinized starch, compressible sugar, such as Di-Pac® (Amstar); mannitol, hydroxypropylmethylcellulose, hydroxypropylmethylcellulose acetate stearate, sucrose-based diluents, confectioner's sugar; monobasic calcium sulfate monohydrate, calcium sulfate dihydrate; calcium lactate trihydrate, dextrates; hydrolyzed cereal solids, amylose; powdered cellulose, calcium carbonate; glycine, kaolin; mannitol, sodium chloride; inositol, bentonite, and the like.

In some embodiments, pharmaceutical compositions or formulations include disintegration agents or disintegrants to facilitate the breakup or disintegration of a substance. The term “disintegrate” includes both the dissolution and dispersion of the dosage form when contacted with gastrointestinal fluid. Examples of disintegration agents include a starch, e.g., a natural starch such as corn starch or potato starch, a pregelatinized starch such as National 1551 or Amijel®, or sodium starch glycolate such as Promogel® or Explotab®, a cellulose such as a wood product, methylcrystalline cellulose, e.g., Avicel®, Avicel® PH101, Avicel® PH102, Avicel® PH105, Elcema® P100, Emcocel®, Vivacel®, Ming Tia®, and Solka-Floc®, methylcellulose, croscarmellose, or a cross-linked cellulose, such as cross-linked sodium carboxymethylcellulose (Ac-Di-Sol®)), cross-linked carboxymethylcellulose, or cross-linked croscarmello se, a cross-linked starch such as sodium starch glycolate, a cross-linked polymer such as crospovidone, a cross-linked polyvinylpyrrolidone, alginate such as alginic acid or a salt of alginic acid such as sodium alginate, a clay such as Veegum® HV (magnesium aluminum silicate), a gum such as agar, guar, locust bean, Karaya, pectin, or tragacanth, sodium starch glycolate, bentonite, a natural sponge, a surfactant, a resin such as a cation-exchange resin, citrus pulp, sodium lauryl sulfate, sodium lauryl sulfate in combination starch, and the like.

In some embodiments, pharmaceutical formulations include filling agents such as lactose, calcium carbonate, calcium phosphate, dibasic calcium phosphate, calcium sulfate, microcrystalline cellulose, cellulose powder, dextrose, dextrates, dextran, starches, pregelatinized starch, sucrose, xylitol, lactitol, mannitol, sorbitol, sodium chloride, polyethylene glycol, and the like.

In some embodiments, pharmaceutical compositions or formulations include flavoring agents and/or sweeteners” such as for example, acacia syrup, acesulfame K, alitame, anise, apple, aspartame, banana, Bavarian cream, berry, black currant, butterscotch, calcium citrate, camphor, caramel, cherry, cherry cream, chocolate, cinnamon, bubble gum, citrus, citrus punch, citrus cream, cotton candy, cocoa, cola, cool cherry, cool citrus, cyclamate, cylamate, dextrose, eucalyptus, eugenol, fructose, fruit punch, ginger, glycyrrhetinate, glycyrrhiza (licorice) syrup, grape, grapefruit, honey, isomalt, lemon, lime, lemon cream, monoammonium glyrrhizinate (MagnaSweet®), maltol, mannitol, maple, marshmallow, menthol, mint cream, mixed berry, neohesperidine DC, neotame, orange, pear, peach, peppermint, peppermint cream, Prosweet® Powder, raspberry, root beer, rum, saccharin, safrole, sorbitol, spearmint, spearmint cream, strawberry, strawberry cream, stevia, sucralose, sucrose, sodium saccharin, saccharin, aspartame, acesulfame potassium, mannitol, talin, sylitol, sucralose, sorbitol, Swiss cream, tagatose, tangerine, thaumatin, tutti fruitti, vanilla, walnut, watermelon, wild cherry, wintergreen, xylitol, or any combination of these flavoring ingredients, e.g., anise-menthol, cherry-anise, cinnamon-orange, cherry-cinnamon, chocolate-mint, honey-lemon, lemon-lime, lemon-mint, menthol-eucalyptus, orange-cream, vanilla-mint, and mixtures thereof.

Lubricants and glidants also included in the pharmaceutical compositions or formulations described herein, for example, include those that prevent, reduce or inhibit adhesion or friction of materials. Exemplary lubricants include, e.g., stearic acid, calcium hydroxide, talc, sodium stearyl fumerate, a hydrocarbon such as mineral oil, or hydrogenated vegetable oil such as hydrogenated soybean oil (Sterotex®)), higher fatty acids and their alkali-metal and alkaline earth metal salts, such as aluminum, calcium, magnesium, zinc, stearic acid, sodium stearates, glycerol, talc, waxes, Stearowet®, boric acid, sodium benzoate, sodium acetate, sodium chloride, leucine, a polyethylene glycol (e.g., PEG-4000) or a methoxypolyethylene glycol such as Carbowax™, sodium oleate, sodium benzoate, glyceryl behenate, polyethylene glycol, magnesium or sodium lauryl sulfate, colloidal silica such as Syloid™, Cab-O-Sil®, a starch such as corn starch, silicone oil, a surfactant, and the like.

Plasticizers include compounds used to soften the microencapsulation material or film coatings to make them less brittle. Suitable plasticizers include, e.g., polyethylene glycols such as PEG 300, PEG 400, PEG 600, PEG 1450, PEG 3350, and PEG 800, stearic acid, propylene glycol, oleic acid, triethyl cellulose and triacetin. Plasticizers also function as dispersing agents or wetting agents.

Solubilizers include compounds such as triacetin, triethylcitrate, ethyl oleate, ethyl caprylate, sodium lauryl sulfate, sodium doccusate, vitamin E TPGS, dimethylacetamide, N-methylpyrrolidone, N-hydroxyethylpyrrolidone, polyvinylpyrrolidone, hydroxypropylmethyl cellulose, hydroxypropyl cyclodextrins, ethanol, n-butanol, isopropyl alcohol, cholesterol, bile salts, polyethylene glycol 200-600, glycofurol, transcutol, propylene glycol, and dimethyl isosorbide and the like.

Stabilizers include compounds such as any antioxidation agents, buffers, acids, preservatives and the like.

Suspending agents include compounds such as polyvinylpyrrolidone, e.g., polyvinylpyrrolidone K12, polyvinylpyrrolidone K17, polyvinylpyrrolidone K25, or polyvinylpyrrolidone K30, vinyl pyrrolidone/vinyl acetate copolymer (S630), polyethylene glycol, e.g., the polyethylene glycol have a molecular weight of about 300 to about 6000, or about 3350 to about 4000, or about 7000 to about 5400, sodium carboxymethylcellulose, methylcellulose, hydroxypropylmethylcellulo se, hydroxymethylcellulose acetate stearate, polysorbate-80, hydroxyethylcellulose, sodium alginate, gums, such as, e.g., gum tragacanth and gum acacia, guar gum, xanthans, including xanthan gum, sugars, cellulosics, such as, e.g., sodium carboxymethylcellulose, methylcellulo se, sodium carboxymethylcellulo se, hydroxypropylmethylcellulose, hydroxyethylcellulose, polysorbate-80, sodium alginate, polyethoxylated sorbitan monolaurate, polyethoxylated sorbitan monolaurate, povidone and the like.

Surfactants include compounds such as sodium lauryl sulfate, sodium docusate, Tween 60 or 80, triacetin, vitamin E TPGS, sorbitan monooleate, polyoxyethylene sorbitan monooleate, polysorbates, polaxomers, bile salts, glyceryl monostearate, copolymers of ethylene oxide and propylene oxide, e.g., Pluronic® (BASF), and the like. Additional surfactants include polyoxyethylene fatty acid glycerides and vegetable oils, e.g., polyoxyethylene (60) hydrogenated castor oil; and polyoxyethylene alkylethers and alkylphenyl ethers, e.g., octoxynol 10, octoxynol 40. Sometimes, surfactants are included to enhance physical stability or for other purposes.

Viscosity enhancing agents include, e.g., methyl cellulose, xanthan gum, carboxymethyl cellulose, hydroxypropyl cellulose, hydroxypropylmethyl cellulose, hydroxypropylmethyl cellulose acetate stearate, hydroxypropylmethyl cellulose phthalate, carbomer, polyvinyl alcohol, alginates, acacia, chitosans and combinations thereof.

Wetting agents include compounds such as oleic acid, glyceryl monostearate, sorbitan monooleate, sorbitan monolaurate, triethanolamine oleate, polyoxyethylene sorbitan monooleate, polyoxyethylene sorbitan monolaurate, sodium docusate, sodium oleate, sodium lauryl sulfate, sodium doccusate, triacetin, Tween 80, vitamin E TPGS, ammonium salts and the like.

Injectable Formulations

Formulations suitable for intramuscular, intratympanic, intracochlear, subcutaneous, or intravenous injection include physiologically acceptable sterile aqueous or non-aqueous solutions, dispersions, suspensions or emulsions, and sterile powders for reconstitution into sterile injectable solutions or dispersions. Examples of suitable aqueous and non-aqueous carriers, diluents, solvents, or vehicles include water, ethanol, polyols (propyleneglycol, polyethylene-glycol, glycerol, cremophor and the like), suitable mixtures thereof, vegetable oils (such as olive oil) and injectable organic esters such as ethyl oleate. Proper fluidity is maintained, for example, by the use of a coating such as lecithin, by the maintenance of the required particle size in the case of dispersions, and by the use of surfactants. Formulations suitable for subcutaneous injection also contain additives such as preserving, wetting, emulsifying, and dispensing agents. Prevention of the growth of microorganisms is ensured by various antibacterial and antifungal agents, such as parabens, chlorobutanol, phenol, sorbic acid, and the like. It also is desirable to include isotonic agents, such as sugars, sodium chloride, and the like. Prolonged absorption of the injectable pharmaceutical form is brought about by the use of agents delaying absorption, such as aluminum monostearate and gelatin.

For intravenous injections, compounds described herein are formulated in aqueous solutions, preferably in physiologically compatible buffers such as Hank's solution, Ringer's solution, or physiological saline buffer. For transmucosal administration, penetrants appropriate to the barrier to be permeated are used in the formulation. Such penetrants are generally known in the art. For other parenteral injections, appropriate formulations include aqueous or nonaqueous solutions, preferably with physiologically compatible buffers or excipients. Such excipients are generally known in the art.

In some instances, parenteral injections involve bolus injection or continuous infusion. Formulations for injection is presented in unit dosage form, e.g., in ampoules or in multi-dose containers, with an added preservative. The pharmaceutical composition described herein is in a form suitable for parenteral injection as a sterile suspensions, solutions or emulsions in oily or aqueous vehicles, and contains formulatory agents such as suspending, stabilizing and/or dispersing agents. Pharmaceutical formulations for parenteral administration include aqueous solutions of the active compounds in water-soluble form. Additionally, suspensions of the active compounds are prepared as appropriate oily injection suspensions. Suitable lipophilic solvents or vehicles include fatty oils such as sesame oil, or synthetic fatty acid esters, such as ethyl oleate or triglycerides, or liposomes. Aqueous injection suspensions contain substances which increase the viscosity of the suspension, such as sodium carboxymethyl cellulose, sorbitol, or dextran. Optionally, the suspension also contains suitable stabilizers or agents which increase the solubility of the compounds to allow for the preparation of highly concentrated solutions. Alternatively, the active ingredient is in powder form for constitution with a suitable vehicle, e.g., sterile pyrogen-free water, before use.

Oral Formulations

Pharmaceutical preparations for oral use are obtained by mixing one or more solid excipient with one or more of the compounds described herein, optionally grinding the resulting mixture, and processing the mixture of granules, after adding suitable auxiliaries, if desired, to obtain tablets or dragee cores. Suitable excipients include, for example, fillers such as sugars, including lactose, sucrose, mannitol, or sorbitol; cellulose preparations such as, for example, maize starch, wheat starch, rice starch, potato starch, gelatin, gum tragacanth, methylcellulose, microcrystalline cellulose, hydroxypropylmethylcellulo se, sodium carboxymethylcellulose; or others such as: polyvinylpyrrolidone (PVP or povidone) or calcium phosphate. If desired, disintegrating agents are added, such as the cross-linked croscarmellose sodium, polyvinylpyrrolidone, agar, or alginic acid or a salt thereof such as sodium alginate.

Dragee cores are provided with suitable coatings. For this purpose, concentrated sugar solutions are used, which optionally contain gum arabic, talc, polyvinylpyrrolidone, carbopol gel, polyethylene glycol, and/or titanium dioxide, lacquer solutions, and suitable organic solvents or solvent mixtures. Dyestuffs or pigments are added to the tablets or dragee coatings for identification or to characterize different combinations of active compound doses.

Solid dosage forms are in the form of a tablet, (including a suspension tablet, a fast-melt tablet, a bite-disintegration tablet, a rapid-disintegration tablet, an effervescent tablet, or a caplet), a pill, a powder (including a sterile packaged powder, a dispensable powder, or an effervescent powder) a capsule (including both soft or hard capsules, e.g., capsules made from animal-derived gelatin or plant-derived HPMC, or “sprinkle capsules”), solid dispersion, solid solution, bioerodible dosage form, controlled release formulations, pulsatile release dosage forms, multiparticulate dosage forms, pellets, granules, or an aerosol. In other instances, the pharmaceutical formulation is in the form of a powder. In still other instances, the pharmaceutical formulation is in the form of a tablet, including but not limited to, a fast-melt tablet. Additionally, pharmaceutical formulations described herein are administered as a single capsule or in multiple capsule dosage form. In some cases, the pharmaceutical formulation is administered in two, or three, or four, capsules or tablets.

In some embodiments, the pharmaceutical solid dosage forms include a composition described herein and one or more pharmaceutically acceptable additives such as a compatible carrier, binder, filling agent, suspending agent, flavoring agent, sweetening agent, disintegrating agent, dispersing agent, surfactant, lubricant, colorant, diluent, solubilizer, moistening agent, plasticizer, stabilizer, penetration enhancer, wetting agent, anti-foaming agent, antioxidant, preservative, or one or more combination thereof. In still other aspects, using standard coating procedures, such as those described in Remington's Pharmaceutical Sciences, 20th Edition (2000).

In some embodiments, suitable carriers for use in the solid dosage forms include, but are not limited to, acacia, gelatin, colloidal silicon dioxide, calcium glycerophosphate, calcium lactate, maltodextrin, glycerine, magnesium silicate, sodium caseinate, soy lecithin, sodium chloride, tricalcium phosphate, dipotassium phosphate, sodium stearoyl lactylate, carrageenan, monoglyceride, diglyceride, pregelatinized starch, hydroxypropylmethylcellulose, hydroxypropylmethylcellulose acetate stearate, sucrose, microcrystalline cellulose, lactose, mannitol and the like.

In some embodiments, suitable filling agents for use in the solid dosage forms include, but are not limited to, lactose, calcium carbonate, calcium phosphate, dibasic calcium phosphate, calcium sulfate, microcrystalline cellulose, cellulose powder, dextrose, dextrates, dextran, starches, pregelatinized starch, hydroxypropylmethycellulose (HPMC), hydroxypropylmethycellulo se phthalate, hydroxypropylmethylcellulose acetate stearate (HPMCAS), sucrose, xylitol, lactitol, mannitol, sorbitol, sodium chloride, polyethylene glycol, and the like.

Binders impart cohesiveness to solid oral dosage form formulations: for powder filled capsule formulation, they aid in plug formation that are filled into soft or hard shell capsules and for tablet formulation, they ensure the tablet remaining intact after compression and help assure blend uniformity prior to a compression or fill step. Materials suitable for use as binders in the solid dosage forms described herein include, but are not limited to, carboxymethylcellulose, methylcellulose (e.g., Methocel®), hydroxypropylmethylcellulose (e.g. Hypromellose USP Pharmacoat-603, hydroxypropylmethylcellulose acetate stearate (Aqoate HS-LF and HS), hydroxyethylcellulose, hydroxypropylcellulose (e.g., Kluce®), ethylcellulose (e.g., Ethocel®), and microcrystalline cellulose (e.g., Avicel®), microcrystalline dextrose, amylose, magnesium aluminum silicate, polysaccharide acids, bentonites, gelatin, polyvinylpyrrolidone/vinyl acetate copolymer, crospovidone, povidone, starch, pregelatinized starch, tragacanth, dextrin, a sugar, such as sucrose (e.g., Dipac®), glucose, dextrose, molasses, mannitol, sorbitol, xylitol (e.g., Xylitab®), lactose, a natural or synthetic gum such as acacia, tragacanth, ghatti gum, mucilage of isapol husks, starch, polyvinylpyrrolidone (e.g., Povidone® CL, Kollidon® CL, Polyplasdone® XL-10, and Povidone® K-12), larch arabogalactan, Veegum®, polyethylene glycol, waxes, sodium alginate, and the like.

Suitable lubricants or glidants for use in the solid dosage forms include, but are not limited to, stearic acid, calcium hydroxide, talc, corn starch, sodium stearyl fumerate, alkali-metal and alkaline earth metal salts, such as aluminum, calcium, magnesium, zinc, stearic acid, sodium stearates, magnesium stearate, zinc stearate, waxes, Stearowet®, boric acid, sodium benzoate, sodium acetate, sodium chloride, leucine, a polyethylene glycol or a methoxypolyethylene glycol such as Carbowax™, PEG 4000, PEG 5000, PEG 6000, propylene glycol, sodium oleate, glyceryl behenate, glyceryl palmitostearate, glyceryl benzoate, magnesium or sodium lauryl sulfate, and the like.

Suitable diluents for use in the solid dosage forms include, but are not limited to, sugars (including lactose, sucrose, and dextrose), polysaccharides (including dextrates and maltodextrin), polyols (including mannitol, xylitol, and sorbitol), cyclodextrins and the like.

Suitable wetting agents for use in the solid dosage forms include, for example, oleic acid, glyceryl monostearate, sorbitan monooleate, sorbitan monolaurate, triethanolamine oleate, polyoxyethylene sorbitan monooleate, polyoxyethylene sorbitan monolaurate, quaternary ammonium compounds (e.g., Polyquat 10®), sodium oleate, sodium lauryl sulfate, magnesium stearate, sodium docusate, triacetin, vitamin E TPGS and the like.

Suitable surfactants for use in the solid dosage forms include, for example, sodium lauryl sulfate, sorbitan monooleate, polyoxyethylene sorbitan monooleate, polysorbates, polaxomers, bile salts, glyceryl monostearate, copolymers of ethylene oxide and propylene oxide, e.g., Pluronic® (BASF), and the like.

Suitable suspending agents for use in the solid dosage forms include, but are not limited to, polyvinylpyrrolidone, e.g., polyvinylpyrrolidone K12, polyvinylpyrrolidone K17, polyvinylpyrrolidone K25, or polyvinylpyrrolidone K30, polyethylene glycol, e.g., the polyethylene glycol have a molecular weight of about 300 to about 6000, or about 3350 to about 4000, or about 7000 to about 5400, vinyl pyrrolidone/vinyl acetate copolymer (S630), sodium carboxymethylcellulose, methylcellulose, hydroxy-propylmethylcellulo se, polysorbate-80, hydroxyethylcellulose, sodium alginate, gums, such as, e.g., gum tragacanth and gum acacia, guar gum, xanthans, including xanthan gum, sugars, cellulosics, such as, e.g., sodium carboxymethylcellulose, methylcellulose, sodium carboxymethylcellulose, hydroxypropylmethylcellulo se, hydroxyethylcellulo se, polysorbate-80, sodium alginate, polyethoxylated sorbitan monolaurate, polyethoxylated sorbitan monolaurate, povidone and the like.

Suitable antioxidants for use in the solid dosage forms include, for example, e.g., butylated hydroxytoluene (BHT), sodium ascorbate, and tocopherol.

Liquid formulation dosage forms for oral administration include aqueous suspensions selected from the group including, but not limited to, pharmaceutically acceptable aqueous oral dispersions, emulsions, solutions, elixirs, gels, and syrups. See, e.g., Singh et al., Encyclopedia of Pharmaceutical Technology, 2^(nd) Ed., pp. 754-757 (2002). In addition the liquid dosage forms include additives, such as: (a) disintegrating agents; (b) dispersing agents; (c) wetting agents; (d) at least one preservative, (e) viscosity enhancing agents, (f) at least one sweetening agent, and (g) at least one flavoring agent. In some embodiments, the aqueous dispersions further include a crystalline inhibitor.

In some embodiments, the aqueous suspensions and dispersions described herein remain in a homogenous state, as defined in The USP Pharmacists' Pharmacopeia (2005 edition, chapter 905), for at least 4 hours. The homogeneity should be determined by a sampling method consistent with regard to determining homogeneity of the entire composition. In one embodiment, an aqueous suspension is re-suspended into a homogenous suspension by physical agitation lasting less than 1 minute. In another aspect, an aqueous suspension is re-suspended into a homogenous suspension by physical agitation lasting less than 45 seconds. In yet another aspect, an aqueous suspension is re-suspended into a homogenous suspension by physical agitation lasting less than 30 seconds. In still another embodiment, no agitation is necessary to maintain a homogeneous aqueous dispersion.

In another aspect, dosage forms include microencapsulated formulations. In some embodiments, one or more other compatible materials are present in the microencapsulation material. Exemplary materials include, but are not limited to, pH modifiers, erosion facilitators, anti-foaming agents, antioxidants, flavoring agents, and carrier materials such as binders, suspending agents, disintegration agents, filling agents, surfactants, solubilizers, stabilizers, lubricants, wetting agents, and diluents.

Exemplary microencapsulation materials useful for delaying the release of the formulations including compounds described herein, include, but are not limited to, hydroxypropyl cellulose ethers (HPC) such as Klucel® or Nisso HPC, low-substituted hydroxypropyl cellulose ethers (L-HPC), hydroxypropyl methyl cellulose ethers (HPMC) such as Seppifilm-LC, Pharmacoat®, Metolose SR, Methocel®-E, Opadry YS, PrimaFlo, Benecel MP824, and Benecel MP843, methylcellulose polymers such as Methocer-A, hydroxypropylmethylcellulose acetate stearate Aqoat (HF-LS, HF-LG,HF-MS) and Metolose®, Ethylcelluloses (EC) and mixtures thereof such as E461, Ethocel®, Aqualon®-EC, Surelease®, Polyvinyl alcohol (PVA) such as Opadry AMB, hydroxyethylcelluloses such as Natrosol®, carboxymethylcelluloses and salts of carboxymethylcelluloses (CMC) such as Aqualon®-CMC, polyvinyl alcohol and polyethylene glycol co-polymers such as Kollicoat IR®, monoglycerides (Myverol), triglycerides (KLX), polyethylene glycols, modified food starch, acrylic polymers and mixtures of acrylic polymers with cellulose ethers such as Eudragit® EPO, Eudragit® L30D-55, Eudragit® FS 30D Eudragit® L100-55, Eudragit® L100, Eudragit® S100, Eudragit® RD100, Eudragit® E100, Eudragit® L12.5, Eudragit® S12.5, Eudragit® NE30D, and Eudragit® NE 40D, cellulose acetate phthalate, sepifilms such as mixtures of HPMC and stearic acid, cyclodextrins, and mixtures of these materials.

Plasticizers include polyethylene glycols, e.g., PEG 300, PEG 400, PEG 600, PEG 1450, PEG 3350, and PEG 800, stearic acid, propylene glycol, oleic acid, and triacetin are incorporated into the microencapsulation material. In other embodiments, the microencapsulating material useful for delaying the release of the pharmaceutical compositions is from the USP or the National Formulary (NF). In yet other embodiments, the microencapsulation material is Klucel. In still other embodiments, the microencapsulation material is methocel.

Microencapsulated compositions are formulated by methods known by one of ordinary skill in the art. Such known methods include, e.g., spray drying processes, spinning disk-solvent processes, hot melt processes, spray chilling methods, fluidized bed, electrostatic deposition, centrifugal extrusion, rotational suspension separation, polymerization at liquid-gas or solid-gas interface, pressure extrusion, or spraying solvent extraction bath. In addition to these, several chemical techniques, e.g., complex coacervation, solvent evaporation, polymer-polymer incompatibility, interfacial polymerization in liquid media, in situ polymerization, in-liquid drying, and desolvation in liquid media are also used. Furthermore, other methods such as roller compaction, extrusion/spheronization, coacervation, or nanoparticle coating are also used.

Intranasal Formulations

Intranasal formulations are known in the art and are described in, for example, U.S. Pat. Nos. 4,476,116 and 6,391,452. Formulations that include the compositions described herein, which are prepared according to the above described and other techniques well-known in the art are prepared as solutions in saline, employing benzyl alcohol or other suitable preservatives, fluorocarbons, and/or other solubilizing or dispersing agents known in the art. See, for example, Ansel, H. C. et al., Pharmaceutical Dosage Forms and Drug Delivery Systems, Sixth Ed. (1995). Preferably these compositions and formulations are prepared with suitable nontoxic pharmaceutically acceptable ingredients. These ingredients are known to those skilled in the preparation of nasal dosage forms and some of these are found in Remington: The Science and Practice of Pharmacy, 21st edition, 2005, a standard reference in the field. The choice of suitable carriers is highly dependent upon the exact nature of the nasal dosage form desired, e.g., solutions, suspensions, ointments, or gels. Nasal dosage forms generally contain large amounts of water in addition to the active ingredient. Minor amounts of other ingredients such as pH adjusters, emulsifiers or dispersing agents, preservatives, surfactants, gelling agents, or buffering and other stabilizing and solubilizing agents are also present. The nasal dosage form should be isotonic with nasal secretions.

For administration by inhalation described herein include aerosol, mist or powder. Pharmaceutical compositions described herein are conveniently delivered in the form of an aerosol spray presentation from pressurized packs or a nebulizer, with the use of a suitable propellant, e.g., dichlorodifluoromethane, trichlorofluoromethane, dichlorotetrafluoroethane, carbon dioxide or other suitable gas. In the case of a pressurized aerosol, the dosage unit is determined by providing a valve to deliver a metered amount. Capsules and cartridges of, such as, by way of example only, gelatin for use in an inhaler or insufflator are formulated containing a powder mix of the compound described herein and a suitable powder base such as lactose or starch.

Dosing and Treatment Regimens

In some embodiments, the pharmaceutical compositions described herein are administered for therapeutic applications. In some embodiments, the pharmaceutical compositions described herein are also administered as a maintenance therapy, for example for a patient in remission. In some embodiments, the pharmaceutical composition is administered once per day, twice per day, three times per day or more. In some embodiments, the pharmaceutical composition is administered daily, every day, every alternate day, five days a week, once a week, every other week, two weeks per month, three weeks per month, once a month, twice a month, three times per month, or more. In some embodiments, the pharmaceutical composition is administered for at least 1 month, 2 months, 3 months, 4 months, 5 months, 6 months, 7 months, 8 months, 9 months, 10 months, 11 months, 12 months, 18 months, 2 years, 3 years, or more.

In the case wherein the patient's status does improve, upon the doctor's discretion the administration of the compounds is given continuously; alternatively, the dose of drug being administered is temporarily reduced or temporarily suspended for a certain length of time (i.e., a “drug holiday”). The length of the drug holiday varies between 2 days and 1 year, including by way of example only, 2 days, 3 days, 4 days, 5 days, 6 days, 7 days, 10 days, 12 days, 15 days, 20 days, 28 days, 35 days, 50 days, 70 days, 100 days, 120 days, 150 days, 180 days, 200 days, 250 days, 280 days, 300 days, 320 days, 350 days, or 365 days. The dose reduction during a drug holiday is from 10%-100%, including, by way of example only, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, or 100%.

Once improvement of the patient's conditions has occurred, a maintenance dose is administered if necessary. Subsequently, the dosage or the frequency of administration, or both, are reduced, as a function of the symptoms, to a level at which the improved disease, disorder or condition is retained. In some instances, patients, however, require intermittent treatment of a pharmaceutical composition described herein on a long-term basis upon any recurrence of symptoms.

In some embodiments, the amount of a given agent that corresponds to such an amount varies depending upon factors such as the particular compound, the severity of the disease, the identity (e.g., weight) of the subject or host in need of treatment, but nevertheless is routinely determined in a manner known in the art according to the particular circumstances surrounding the case, including, e.g., the specific agent being administered, the route of administration, and the subject or host being treated. In some instances, the desired dose is conveniently presented in a single dose or as divided doses administered simultaneously (or over a short period of time) or at appropriate intervals, for example as two, three, four or more sub-doses per day.

In some embodiments, the pharmaceutical composition described herein is in unit dosage forms suitable for single administration of precise dosages. In unit dosage form, the formulation is divided into unit doses containing appropriate quantities of one or more compound. In some embodiments, the unit dosage is in the form of a package containing discrete quantities of the formulation. Non-limiting examples are packaged tablets or capsules, and powders in vials or ampoules. Aqueous suspension compositions in some instances are packaged in single-dose non-redo sable containers. Alternatively, multiple-dose redo sable containers in some instances are used, in which case it is typical to include a preservative in the composition. By way of example only, formulations for parenteral injection are presented in unit dosage form, which include, but are not limited to ampoules, or in multi-dose containers, with an added preservative.

The foregoing ranges are merely suggestive, as the number of variables in regard to an individual treatment regime is large, and considerable excursions from these recommended values are not uncommon. Such dosages are altered depending on a number of variables, not limited to the activity of the compound used, the disease or condition to be treated, the mode of administration, the requirements of the individual subject, the severity of the disease or condition being treated, and the judgment of the practitioner.

In some embodiments, toxicity and therapeutic efficacy of such therapeutic regimens are determined by standard pharmaceutical procedures in cell cultures or experimental animals, including, but not limited to, the determination of the LD50 (the dose lethal to 50% of the population) and the ED50 (the dose therapeutically effective in 50% of the population). The dose ratio between the toxic and therapeutic effects is the therapeutic index and it is expressed as the ratio between LD50 and EDS° . Compounds exhibiting high therapeutic indices are preferred. The data obtained from cell culture assays and animal studies are used in formulating a range of dosage for use in human. The dosage of such compounds lies preferably within a range of circulating concentrations that include the ED50 with minimal toxicity. The dosage varies within this range depending upon the dosage form employed and the route of administration utilized.

According to another aspect of the invention, there is provided a method of selecting a subject for treatment, comprising determining if the subject has a disease induced by defective protein expression caused by the intron retention in gene transcripts, wherein the subject is selected for treatment upon positive confirmation; and optionally treating the subject.

Diagnostic Methods

In certain embodiments, also included are methods of stratifying an individual having an otic disease or condition for treatment with a pharmaceutical composition described herein and methods of optimizing the therapy of an individual receiving a pharmaceutical composition described herein for treatment of an otic disease or condition. In some instances, disclosed herein is a method of stratifying an individual having an otic disease or condition for treatment with a pharmaceutical composition described herein, comprising: determining the expression level of a truncated TrkC or truncated TrkB; and administering to the individual a therapeutically effective amount of the pharmaceutical composition if there is an elevated expression level of the truncated TrkC or truncated TrkB. In some instances, also disclosed herein is a method of optimizing the therapy of an individual receiving a pharmaceutical composition described herein for treatment of an otic disease or condition, comprising: determining the expression level of a truncated TrkC or truncated TrkB; and modifying, discontinuing, or continuing the treatment based on the expression level of the truncated TrkC or truncated TrkB.

Methods for determining the expression and/or activity of truncated TrkC and/or truncated TrkB are well known in the art. In some embodiments, the expression levels are measured at either nucleic acid level or protein level, and by methods such as RT-PCR, Qt-PCR, micro array, Northern blot, ELISA, radioimmunoassay (RIA), electrochemiluminescence (ECL), Western blot, multiplexing technologies, or other similar methods. In some embodiments, activities of the truncated TrkC and/or truncated TrkB are measured by methods such as co-immunoprecipitation, fluorescence spectroscopy, fluorescence resonance energy transfer (FRET), isothermal titration calorimetry (ITC), dynamic light scattering (DLS), surface plasmon resonance (SPR), or other similar methods.

In some embodiments, the expression of truncated TrkC and/or truncated TrkB is determined at the nucleic acid level. Nucleic acid-based techniques for assessing expression are well known in the art and include, for example, determining the level of biomarker mRNA in a biological sample. Many expression detection methods use isolated RNA. Any RNA isolation technique that does not select against the isolation of mRNA is utilized for the purification of RNA (see, e.g., Ausubel et al., ed. (1987-1999) Current Protocols in Molecular Biology (John Wiley & Sons, New York). Additionally, large numbers of tissue samples are readily processed using techniques well known to those of skill in the art, such as, for example, the single-step RNA isolation process disclosed in U.S. Pat. No. 4,843,155.

Thus, in some embodiments, the detection of a biomarker such as truncated TrkC or truncated TrkB is assayed at the nucleic acid level using nucleic acid probes. The term “nucleic acid probe” refers to any molecule that is capable of selectively binding to a specifically intended target nucleic acid molecule, for example, a nucleotide transcript. Probes are synthesized by one of skill in the art, or derived from appropriate biological preparations. Probes are specifically designed to be labeled, for example, with a radioactive label, a fluorescent label, an enzyme, a chemiluminescent tag, a colorimetric tag, or other labels or tags that are discussed above or that are known in the art. Examples of molecules that are utilized as probes include, but are not limited to, RNA and DNA.

For example, isolated mRNA are used in hybridization or amplification assays that include, but are not limited to, Southern or Northern analyses, polymerase chain reaction analyses and probe arrays. One method for the detection of mRNA levels involves contacting the isolated mRNA with a nucleic acid molecule (probe) that hybridize to the mRNA encoded by the gene being detected. The nucleic acid probe comprises of, for example, a full-length cDNA, or a portion thereof, such as an oligonucleotide of at least 7, 15, 30, 50, 100, 250 or 500 nucleotides in length and sufficient to specifically hybridize under stringent conditions to an mRNA or genomic DNA encoding a biomarker, biomarker described herein above. Hybridization of an mRNA with the probe indicates that the biomarker or other target protein of interest is being expressed.

In one embodiment, the mRNA is immobilized on a solid surface and contacted with a probe, for example by running the isolated mRNA on an agarose gel and transferring the mRNA from the gel to a membrane, such as nitrocellulose. In an alternative embodiment, the probe(s) are immobilized on a solid surface and the mRNA is contacted with the probe(s), for example, in a gene chip array. A skilled artisan readily adapts known mRNA detection methods for use in detecting the level of mRNA encoding the biomarkers or other proteins of interest.

An alternative method for determining the level of an mRNA of interest in a sample involves the process of nucleic acid amplification, e.g., by RT-PCR (see, for example, U.S. Pat. No. 4,683,202), ligase chain reaction (Barany (1991) Proc. Natl. Acad. Sci. USA 88:189 193), self-sustained sequence replication (Guatelli et al. (1990) Proc. Natl. Acad. Sci. USA 87:1874-1878), transcriptional amplification system (Kwoh et al. (1989) Proc. Natl. Acad. Sci. USA 86:1173-1177), Q-Beta Replicase (Lizardi et al. (1988) Bio/Technology 6:1197), rolling circle replication (U.S. Pat. No. 5,854,033) or any other nucleic acid amplification method, followed by the detection of the amplified molecules using techniques well known to those of skill in the art. These detection schemes are especially useful for the detection of nucleic acid molecules if such molecules are present in very low numbers. In particular aspects of the invention, biomarker expression is assessed by quantitative fluorogenic RT-PCR (i.e., the TaqMan System).

Expression levels of an RNA of interest are monitored using a membrane blot (such as used in hybridization analysis such as Northern, dot, and the like), or microwells, sample tubes, gels, beads or fibers (or any solid support comprising bound nucleic acids). See U.S. Pat. Nos. 5,770,722, 5,874,219, 5,744,305, 5,677,195 and 5,445,934, which are incorporated herein by reference. The detection of expression also comprises using nucleic acid probes in solution.

In some embodiments, microarrays are used to determine expression of one or more biomarkers of truncated TrkC and/or truncated TrkB. Microarrays are particularly well suited for this purpose because of the reproducibility between different experiments. DNA microarrays provide one method for the simultaneous measurement of the expression levels of large numbers of genes. Each array consists of a reproducible pattern of capture probes attached to a solid support. Labeled RNA or DNA is hybridized to complementary probes on the array and then detected by laser scanning. Hybridization intensities for each probe on the array are determined and converted to a quantitative value representing relative gene expression levels. See, U.S. Pat. Nos. 6,040,138, 5,800,992, 6,020,135, 6,033,860, 6,344,316, and U.S. Pat. Application 20120208706. High-density oligonucleotide arrays are particularly useful for determining the gene expression profile for a large number of RNA's in a sample. Exemplary microarray chips include FoundationOne and FoundationOne Heme from Foundation Medicine, Inc; GeneChip® Human Genome U133 Plus 2.0 array from Affymetrix; and Human DiscoveryMAP® 250+ v. 2.0 from Myraid RBM.

Techniques for the synthesis of these arrays using mechanical synthesis methods are described in, e.g., U.S. Pat. No. 5,384,261. In some embodiments, an array is fabricated on a surface of virtually any shape or even a multiplicity of surfaces. In some embodiments, an array is a planar array surface. In some embodiments, arrays include peptides or nucleic acids on beads, gels, polymeric surfaces, fibers such as fiber optics, glass or any other appropriate substrate, see U.S. Pat. Nos. 5,770,358, 5,789,162, 5,708,153, 6,040,193 and 5,800,992, each of which is hereby incorporated in its entirety for all purposes. In some embodiments, arrays are packaged in such a manner as to allow for diagnostics or other manipulation of an all-inclusive device.

Any means for specifically quantifying a biomarker such as for example truncated TrkC and/or truncated TrkB in the biological sample of a candidate subject is contemplated. Thus, in some embodiments, expression level of a biomarker protein of interest in a biological sample is detected by means of a binding protein capable of interacting specifically with that biomarker protein or a biologically active variant thereof. In some embodiments, labeled antibodies, binding portions thereof, or other binding partners are used. The word “label” when used herein refers to a detectable compound or composition that is conjugated directly or indirectly to the antibody so as to generate a “labeled” antibody. In some embodiments, the label is detectable by itself (e.g., radioisotope labels or fluorescent labels) or, in the case of an enzymatic label, catalyzes chemical alteration of a substrate compound or composition that is detectable.

The antibodies for detection of a biomarker protein are either monoclonal or polyclonal in origin, or are synthetically or recombinantly produced. The amount of complexed protein, for example, the amount of biomarker protein associated with the binding protein, for example, an antibody that specifically binds to the biomarker protein, is determined using standard protein detection methodologies known to those of skill in the art. A detailed review of immunological assay design, theory and protocols are found in numerous texts in the art (see, for example, Ausubel et al., eds. (1995) Current Protocols in Molecular Biology) (Greene Publishing and Wiley-Interscience, NY)); Coligan et al., eds. (1994) Current Protocols in Immunology (John Wiley & Sons, Inc., New York, N.Y.).

The choice of marker used to label the antibodies will vary depending upon the application. However, the choice of the marker is readily determinable to one skilled in the art. These labeled antibodies are used in immunoassays as well as in histological applications to detect the presence of any biomarker of interest. The labeled antibodies are either polyclonal or monoclonal. Further, the antibodies for use in detecting a protein of interest are labeled with a radioactive atom, an enzyme, a chromophoric or fluorescent moiety, or a colorimetric tag as described elsewhere herein. The choice of tagging label also will depend on the detection limitations desired. Enzyme assays (ELISAs) typically allow detection of a colored product formed by interaction of the enzyme-tagged complex with an enzyme substrate. Radionuclides that serve as detectable labels include, for example, 1-131, 1-123, 1-125, Y-90, Re-188, Re-186, At-211, Cu-67, Bi-212, and Pd-109. Examples of enzymes that serve as detectable labels include, but are not limited to, horseradish peroxidase, alkaline phosphatase, beta-galactosidase, and glucose-6-phosphate dehydrogenase. Chromophoric moieties include, but are not limited to, fluorescein and rhodamine. The antibodies are conjugated to these labels by methods known in the art. For example, enzymes and chromophoric molecules are conjugated to the antibodies by means of coupling agents, such as dialdehydes, carbodiimides, dimaleimides, and the like. Alternatively, conjugation occurs through a ligand-receptor pair. Examples of suitable ligand-receptor pairs are biotin-avidin or biotin-streptavidin, and antibody-antigen.

In certain embodiments, expression of one or more biomarkers of interest within a biological sample, for example, a cell sample, is determined by radioimmunoassays or enzyme-linked immunoassays (ELISAs), competitive binding enzyme-linked immunoassays, dot blot (see, for example, Promega Protocols and Applications Guide, Promega Corporation (1991), Western blot (see, for example, Sambrook et al. (1989) Molecular Cloning, A Laboratory Manual, Vol. 3, Chapter 18 (Cold Spring Harbor Laboratory Press, Plainview, N.Y.), chromatography such as high performance liquid chromatography (HPLC), or other assays known in the art. Thus, the detection assays involve steps such as, but not limited to, immunoblotting, immunodiffusion, immunoelectrophoresis, or immunoprecipitation.

In some embodiments, the activities of the truncated TrkC and/or truncated TrkB are measured by methods such as co-immunoprecipitation, fluorescence spectroscopy, fluorescence resonance energy transfer (FRET), isothermal titration calorimetry (ITC), dynamic light scattering (DLS), surface plasmon resonance (SPR), or other similar methods.

Samples

In certain embodiments, one or more of the methods disclosed herein comprise a sample. In some embodiments, the sample is a cell sample or a tissue sample. In some instances, the sample is a cell sample. In additional instances, the sample is a tissue sample. In some embodiments, the sample for use with the methods described herein is obtained from cells or tissues of an animal. In some instances, the animal is a human, a non-human primate, or a rodent.

In some embodiments, the cell or tissue sample comprises neurons or otic cells such as otic hair cells, tectorial cells, Hensen & Claudius cells, pillar cells, or phalangeal cells. In some instances, neurons comprise sensory neurons, interneurons, or motor neurons. In some cases, the sample comprises sensory neurons, interneurons, or motor neurons. In some instances, the sample is a sensory neuron. In some embodiments, the sample comprises otic hair cells, tectorial cells, Hensen & Claudius cells, pillar cells, or phalangeal cells. In some embodiments, the sample is an otic hair cell.

Kits/Article of Manufacture

Disclosed herein, in certain embodiments, are kits and articles of manufacture for use with one or more methods described herein. Such kits include a carrier, package, or container that is compartmentalized to receive one or more containers such as vials, tubes, and the like, each of the container(s) comprising one of the separate elements to be used in a method described herein. Suitable containers include, for example, bottles, vials, syringes, and test tubes. In one embodiment, the containers are formed from a variety of materials such as glass or plastic.

The articles of manufacture provided herein contain packaging materials. Examples of pharmaceutical packaging materials include, but are not limited to, blister packs, bottles, tubes, bags, containers, bottles, and any packaging material suitable for a selected formulation and intended mode of administration and treatment.

For example, the container(s) include one or more of the pharmaceutical compositions described herein comprising an antagonist of a truncated TrkC or truncated TrkB isoform and an excipient and/or delivery vehicle. Such kits optionally include an identifying description or label or instructions relating to its use in the methods described herein.

A kit typically includes labels listing contents and/or instructions for use, and package inserts with instructions for use. A set of instructions will also typically be included.

In one embodiment, a label is on or associated with the container. In one embodiment, a label is on a container when letters, numbers or other characters forming the label are attached, molded or etched into the container itself; a label is associated with a container when it is present within a receptacle or carrier that also holds the container, e.g., as a package insert. In one embodiment, a label is used to indicate that the contents are to be used for a specific therapeutic application. The label also indicates directions for use of the contents, such as in the methods described herein.

In certain embodiments, the pharmaceutical compositions are presented in a pack or dispenser device which contains one or more unit dosage forms containing a compound provided herein. The pack, for example, contains metal or plastic foil, such as a blister pack. In one embodiment, the pack or dispenser device is accompanied by instructions for administration. In one embodiment, the pack or dispenser is also accompanied with a notice associated with the container in form prescribed by a governmental agency regulating the manufacture, use, or sale of pharmaceuticals, which notice is reflective of approval by the agency of the form of the drug for human or veterinary administration. Such notice, for example, is the labeling approved by the U.S. Food and Drug Administration for prescription drugs, or the approved product insert. In one embodiment, compositions containing a compound provided herein formulated in a compatible pharmaceutical carrier are also prepared, placed in an appropriate container, and labeled for treatment of an indicated condition.

Certain Terminology

Unless defined otherwise, all technical and scientific terms used herein have the same meaning as is commonly understood by one of skill in the art to which the claimed subject matter belongs. It is to be understood that the general description and the detailed description are exemplary and explanatory only and are not restrictive of any subject matter claimed. In this application, the use of the singular includes the plural unless specifically stated otherwise. It must be noted that, as used in the specification and the appended claims, the singular forms “a,” “an” and “the” include plural referents unless the context clearly dictates otherwise. In this application, the use of “or” means “and/or” unless stated otherwise. Furthermore, use of the term “including” as well as other forms, such as “include”, “includes,” and “included,” is not limiting.

As used herein, ranges and amounts can be expressed as “about” a particular value or range. About also includes the exact amount. Hence “about 5 μL” means “about 5 μL” and also “5 μL.” Generally, the term “about” includes an amount that would be expected to be within experimental error.

The section headings used herein are for organizational purposes only and are not to be construed as limiting the subject matter described.

As used herein, the terms “individual(s)”, “subject(s)” and “patient(s)” mean any mammal. In some embodiments, the mammal is a human. In some embodiments, the mammal is a non-human. None of the terms require or are limited to situations characterized by the supervision (e.g. constant or intermittent) of a health care worker (e.g. a doctor, a registered nurse, a nurse practitioner, a physician's assistant, an orderly or a hospice worker).

EXAMPLES

These examples are provided for illustrative purposes only and not to limit the scope of the claims provided herein.

Example 1

Delivery of Adenovirus and Lentivirus via the Round Window Membrane

Adenovirus and Lentivirus Constructs and Production

For lentivirus, a short hairpin RNA (shRNA) specifically targeting a unique 3′ sequence of the TrkC T1 mRNA (GGACAATAGAGATCATCTAGT; SEQ ID NO: 1) was cloned in the Lentiviral piLenti-shRNA-GFP lenti expression vector. Lenti vectors were packaged in HEK293 cells and active particles were collected. For adenovirus the same short hairpin RNA (shRNA) specifically targeting a unique 3′ sequence of the TrkC T1 mRNA was cloned into the Adenoviral-Type 5 (dE1/E3) adeno expression vector. Adeno vectors were packaged in HEK293 cells and active particles were purified by CsC1 column, twice.

Adenovirus and Lentivirus in Poloxamer 407

Poloxamer 407 gel at 32% was prepared using the cold method. In brief, a 32% w/w stock solution of poloxamer 407 was prepared by slowly adding it to a cold buffer solution (10 mM PBS, pH 7.4). Sterilization was achieved by filtration. Adenovirus particles in PBS containing 5% glycerol and lentiviral particles in Dulbecco's modified Eagle's medium (DMEM) containing 10% fetal bovine serum were mixed in a 1:1 ratio with 32% poloxamer 407 to yield a solution of virus particles in 16% poloxamer 407.

Pharmacokinetics

Female rats (Charles River) weighing 200-300 g of approximately 12-16 weeks of age served as subjects (N=4 per group). Prior to any procedures, animals were anesthetized using a combination of xylazine (10 mg/kg) and ketamine (90 mg/kg) for up to an hour via the intraperitoneal route. If needed, an intraoperative booster was administered intraperitoneal representing one-tenth of the original dose.

Intratympanic injection—Each animal was positioned so that the head was tilted at an angle to favor injection towards the round window niche. Briefly, under visualization with a surgical microscope, 20 μL of the formulation was injected using a 25 G (Gauge) 1.5 inch needle through the superior posterior quadrant of the tympanic membrane into Round Window (RW) area. Formulations were delivered using an electric perfusion pump at the rate of 2 μL/sec. The formulation dosed on the round window membrane was maintained for 30 minutes by placing the animal in a recumbent position. During the procedure and until recovery, animals were placed on a temperature controlled (40° C.) heating pad until consciousness was regained at which time they were returned to their cages.

Perilymph sampling procedure—The skin behind the ear of anesthetized rats was shaved and disinfected with povidone-iodine. An incision was then made behind the ear, and muscles were carefully retracted from over the bulla. A hole was made through the bulla using a small rongeur so that the middle ear was exposed and accessed. The cochlea and the round window membrane were visualized under a surgical microscope. The basal turn of the bulla was cleaned by using small pieces of cotton ball and absorbent paper tips. A unique microhole was hand drilled through the bony shell of the cochlea (cochlear capsule) adjacent to the round window. Perilymph (about 2 μL) was then collected using a microcapillary tube inserted into the cochlear scala tympani. Perilymph samples were added to DNAase-free microcentrifuge tubes containing 18 μL of sterile RNAase/DNAase-free water and stored at −80° C. until analysis.

Cochlear epithelium collection—Following the collection of perilymph, animals were euthanized by intra-cardiac injection with 0.5 mL of anesthetic cocktail consisting of xylazine (10 mg/kg) and ketamine (90 mg/kg). Animals were then immediately decapitated and the middle ear was removed and opened further to completely expose the cochlea. The bony cochlear tissue was then rinsed twice with 5 mL of sterile PBS then blotted dry. Using fine forceps, the bony cochlear capsule was chipped away and the soft cochlear tissue consisting of the cochlear epithelium, spiral ganglion neurons, and stria vascularis was removed and placed into a sterile DNAase-free microcentrifuge tube containing 200 μl of RNAlater solution and stored at −80° C. until analysis.

Detection of Adenovirus in Perilymph and Cochlea Tissue

Detection of adenovirus in perilymph and cochlea tissue samples was determined by quantitative PCR (qPCR) of DNA for the adenovirus-specific hexon protein.

Perilymph—2 μl of perilymph was added to 18 μl of RNase/DNase-free water. Adenoviral DNA from the sample was prepared according to the kit protocol (Clontech Adeno-X qPCR Titration Kit 632252) as follows: after addition of 130 μl PBS, 5 μl of DNase 1 was added and samples were incubated at 37° C. for 30 min. Carrier RNA in 600 μl of lysis buffer RAV1 and 20 μl of Proteinase K was added was added to each tube followed by thorough vortex mixing. The samples were heated at 70° C. for 5 min. 600 μl of ethanol was added with thorough vortexing and then 700 μl was transferred to a NucleoSpin virus column in a collection tube and centrifuged at 8000 g for 1 min. The remaining 650 μl of the sample was added to the same NucleoSpin filter, followed by centrifugation at 8000 g for 1 min. The flow-through was discarded and 500 μl of RAW buffer was added followed by centrifugation at 8000 g for 1 min. The flow-through was discarded and 600 μl of RAV3 buffer was added followed by centrifugation at 8000 g for 1 min. The filter was placed in a new collection tube and 200 μl of RAV3 buffer added followed by centrifugation at 11000 g for 5 min. The filter was placed into a new tube and 30 μl of RNase/DNase-free water (pre-heated to 70° C.) added with incubation at room temperature for 5 min. After centrifugation at 11000 g for 1 min, the DNA samples were stored at 4 or −20° C.

Cochlea—individual cochlea stored in RNAlater (Sigma-Aldrich) were placed into tubes containing 200 μl PBS and flash frozen. Samples were homogenized at 5 m/sec for a cycle of 30 sec on and 30 sec off with 4 cycles in total. Adenoviral DNA from the sample was prepared according to the kit protocol (Clontech Adeno-X qPCR Titration Kit 632252) as follows: 150 μl of the homogenate was placed in a tube and 5 μl of DNase 1 was added and samples were incubated at 37° C. for 30 min. Carrier RNA in 600 μl of lysis buffer RAV1 and 20 μl of Proteinase K was added was added to each tube followed by thorough vortex mixing. The samples were heated at 70° C. for 5 min. 600 μl of ethanol was added with thorough vortexing and then 700 μl was transferred to a NucleoSpin virus column in a collection tube and centrifuged at 8000 g for 1 min. The remaining 650 μl of the sample was added to the same NucleoSpin filter, followed by centrifugation at 8000 g for 1 min. The flow-through was discarded and 500 μl of RAW buffer was added followed by centrifugation at 8000 g for 1 min. The flow-through was discarded and 600 μl of RAV3 buffer was added followed by centrifugation at 8000 g for 1 min. The filter was placed in a new collection tube and 200 μl of RAV3 buffer added followed by centrifugation at 11000 g for 5 min. The filter was placed into a new tube and 30 μl of RNase/DNase-free water (pre-heated to 70° C.) added with incubation at room temperature for 5 min. After centrifugation at 11000 g for 1 min, the DNA samples were stored at 4 or −20° C.

qPCR: 2 μl samples of DNA from perilymph or cochlea tissue were combined with 18 μl of master mix containing lOpM adeno-X forward primer, 10 μM adeno-X reverse primer, ROX reference dye LMP and SYBR Advantage qPCR premix according to the kit protocol (Clontech Adeno-X qPCR Titration Kit 632252). qPCR was conducted using a ThermoSci QuantiStudio 3 qPCR Machine A28137 according to the kit protocol. Samples were run in quadruplicate

Detection of Lentivirus in Perilymph and Cochlea Tissue

Detection of lentivirus in perilymph and cochlea tissue samples was determined by quantitative PCR (qPCR) of DNA for a conserved region of the HIV-1 genome adjacent to the packaging signal.

Perilymph-2 μl of perilymph was added to 18 μl of RNase/DNase-free water. Lentiviral DNA from the sample was prepared according to the kit protocol (Clontech Lenti-X qPCR Titration Kit 631235) as follows: carrier RNA in 600 μl of lysis buffer RAV1 and 20 μl of Proteinase K was added was added to each tube followed by thorough vortex mixing. The samples were heated at 70° C. for 5 min. 600 μl of ethanol was added with thorough vortexing and then 700 μl was transferred to a NucleoSpin virus column in a collection tube and centrifuged at 8000 g for 1 min. The remaining 650 μl of the sample was added to the same NucleoSpin filter, followed by centrifugation at 8000 g for 1 min. The flow-through was discarded and 500 μl of RAW buffer was added followed by centrifugation at 8000 g for 1 min. The flow-through was discarded and 600 μl of RAV3 buffer was added followed by centrifugation at 8000 g for 1 min. The filter was placed in a new collection tube and 200 μl of RAV3 buffer added followed by centrifugation at 11000 g for 5 min. The filter was placed into a new tube and 30 μl of RNase/DNase-free water (pre-heated to 70° C.) added with incubation at room temperature for 5 min. After centrifugation at 11000 g for 1 min, the DNA samples were stored at 4 or −20° C.

Cochlea—individual cochlea stored in RNAlater (Sigma-Aldrich) were placed into tubes containing 200 μl PBS and flash frozen. Samples were homogenized at 5 m/sec for a cycle of 30 sec on and 30 sec off with 4 cycles in total. Lentiviral DNA from the sample was prepared according to the kit protocol (Clontech Lenti-X qPCR Titration Kit 631235) as follows: 150 μl of the homogenate was placed in a tube. Carrier RNA in 600 μl of lysis buffer RAV1 and 20μl of Proteinase K was added was added to each tube followed by thorough vortex mixing. The samples were heated at 70° C. for 5 min. 600 μl of ethanol was added with thorough vortexing and then 700 μl was transferred to a NucleoSpin virus column in a collection tube and centrifuged at 8000 g for 1 min. The remaining 650 μl of the sample was added to the same NucleoSpin filter, followed by centrifugation at 8000 g for 1 min. The flow-through was discarded and 500 μl of RAW buffer was added followed by centrifugation at 8000 g for 1 min. The flow-through was discarded and 600 μl of RAV3 buffer was added followed by centrifugation at 8000 g for 1 min. The filter was placed in a new collection tube and 200 μl of RAV3 buffer added followed by centrifugation at 11000 g for 5 min. The filter was placed into a new tube and 30 μl of RNase/DNase-free water (pre-heated to 70° C.) added with incubation at room temperature for 5 min. After centrifugation at 11000 g for 1 min, the DNA samples were stored at 4 or −20° C.

qPCR : 2 μl samples of DNA from perilymph or cochlea tissue were combined with 18 μl of master mix containing 10 μM lenti-X forward primer, 10 μM lenti-X reverse primer, ROX reference dye and SYBR Advantage qPCR in Quant-X buffer premix according to the kit protocol (Clontech Lenti-X qPCR Titration Kit 631235). qPCR was conducted using a ThermoSci QuantiStudio 3 qPCR Machine A28137 according to the kit protocol. Samples were run in quadruplicate.

Following round window membrane administration of both adenovirus and lentivirus containing shRNA for TrkC-T1 formulated in poloxamer 407, virus was detected at 4 hours in the perilymph and in the cochlea tissue (FIG. 4 and FIG. 5). For both viruses, substantial levels of virus were detected in the target tissue (cochlea) at 4 hours (adenovirus 20-fold over control; lentivirus 130-fold over control). For both viruses, the levels of viruses were further detected at 24 hours but at lower levels relative to the levels observed at 4 hours.

Example 2

Knock-Down of TrkC.T1 in Rat Cochlea Explants by Viral Delivery of shRNA

Adenovirus and Lentivirus Constructs and Production

For lentivirus, a short hairpin RNA (shRNA) specifically targeting a unique 3′ sequence of the TrkC T1 mRNA (GGACAATAGAGATCATCTAGT; SEQ ID NO: 1) was cloned in the Lentiviral piLenti-shRNA-GFP lenti expression vector. Lenti vectors were packaged in HEK293 cells and active particles were collected. For adenovirus the same short hairpin RNA (shRNA) specifically targeting a unique 3′ sequence of the TrkC T1 mRNA was cloned into the Adenoviral-Type 5 (dE1/E3) adeno expression vector. Adeno vectors were packaged in HEK293 cells and active particles were purified by CsC1 column, twice.

Cochlea Explant/Viral Infection

Postnatal Sprague Dawley rats (P2-4) of both sexes were anesthetized with isoflurane and decapitated. Temporal bones were removed and transferred to a cell culture dish with ice-cold Ca²⁺/Mg²⁺-containing phosphate-buffered saline (PBS; Invitrogen). Under microscopic visualization, the cochlear capsule was carefully removed from the temporal bone using forceps and transferred to a new cell culture dish containing ice-cold PBS. The cochlea was then dissected from the cochlear capsule using fine forceps. The stria vascularis was removed from the cochlear tissue and discarded. The remaining cochlea was then placed in lmL of culture media (Dulbecco's modified Eagle's medium [high glucose, glutamax, 25 mm HEPES] with 10% fetal bovine serum, 1% N2 supplement, 10 units/ml penicillin and 0.1 mg/ml streptomycin) in a 24-well plate. Up to 3 cochleae were placed in one well. Adenovirus or lentivirus was then added directly to the cell culture the same day. The cultures were incubated at 37° C. for 3 days before being processed.

Detection of TrkC-T1 RNA in Cochlea Explants Using qPCR

Following incubation with virus, each cochlea explant was placed in a homogenizing tube with 200 μl lysis solution containing DNase I (Life Technologies Gene Expression Cells-to-Ct Kit 4399002). Samples were flash-frozen and homogenized at 5 m/sec for a cycle of 30 sec on and 30 sec off, 4 cycles in total. Reverse transcription was achieved in PCR strip tubes with 10 μl of cochlea RNA sample and 40 μl of master mix containing 25 μl RT buffer, 2.5 μl RT enzyme mix and 12.5 μl PCR grade water (Life Technologies Gene Expression Cells-to-Ct Kit 4399002). After mixing, the samples were subjected to thermocycling to generate cDNA as follows: 37° C. for 60 min followed by 95° C. for 5 min, then 4° C. hold. To prepare samples for qPCR, 10 μl of SYBER Advantage PCR mix, 0.4 μl of LMP ROX reference dye, 0.4 μl of forward rat TrkC-T1 primer and 0.4 μl of reverse rat TrkC-T1 primer and 6.8 μl of PCR grade water was added to each well in a 96-well qPCR plate (Applied Biosystems MicroAmp Optical 96 well Plates 4306737) and 2 μl of sample cDNA added and the plate tapped to bring contents to the bottom of each well and sealed with adhesive film (Applied Bio systems MicroAmp Optical Adhesive Film 4311971). The same mix but replacing the TrkC-T1 primers with SYBER actin primers (Life Technologies #4402982) was run to determine the housekeeping gene β-actin in each cDNA sample. Each sample was run in quadruplicate. For qPCR the plate was run in a Quantstudio3 (ThermoFisher) with the following program: 50° C. for 2 min, then 95° C. for 10 min, then 95° C. for 150 sec, then 60° C. for 1 min. The last two steps were repeated 40 times. ddCT equations were used to determine fold change of TrkC-T1 RNA from the tissue relative to untreated samples using β-actin as the reference gene. The TrkC-T1 primers were as follows: rat TrkC T1 F 5′ GTCCAGAGTGGGGATGTGTC 3′ (SEQ ID NO: 124); Rat TrkC T1 R 5′ CCATGGTTAAGAGGCTTGGA 3′ (SEQ ID NO: 125).

Exposure of rat cochlea explants to lentivirus containing shRNA for rat TrkC-T1 resulted in a 60-80% reduction of TrkC-T1 mRNA in the tissue over the range of virus concentrations used (10⁵-10⁷ infectious units; FIG. 6). For the adenoviral construct, an approximately 30% reduction of TrkC-T1 mRNA in the tissue was observed at the virus concentration used (10⁹ infectious units; FIG. 7). Adenovirus containing a scrambled shRNA sequence was used as a control and resulted in no reduction in TrkC-T1 mRNA in the tissue (10⁹ infectious units; FIG. 7).

Example 3

Effect of TrkC.T1 Knock-Down on Cochlea Inner Hair Cell Ribbon Synapses in Mice

TrkC.T1 knockout mice: Mice with deletion of TrkC.T1 were generated as described by Bai et al (Invest Ophthalmol Vis Sci 51:6639-6651, 2010). For these experiments, heterozygous (+/−) mice were used that have a reduction, but not complete knock-out of TrkC.T1 to mimic the therapeutic paradigm whereby an TrkC.T1 antagonist would reduce, but not eliminate TrkC.T1 function.

Analytical method: Assessment of cochlear inner hair cell synaptic puncta in 6-month-old TrkC.T1 heterozygous (+/−) and wild type C57BL/6 mice.

Tissue collection and Preparation: Approximately six-month old wild type, TrkC.T1 heterozygous (+/−) mice were deeply anesthetized and then cardiac perfused with saline then 4% PFA to rapidly fix all tissues. Fixed animals were then decapitated and the heads were placed into 4% PFA for at least 24 hours. Fixed heads were then rinsed in PBS and either stored at 4° C. or immediately dissected further. To isolate the cochleae, the heads were bisected midsagitally and both halves of the brain were removed to expose the temporal bones. Extra cranial tissue was removed from the temporal bones to expose the middle ear bulla, which were then opened to reveal the cochleae. One isolated cochlea from each animal was then incubated in 10% EDTA for 48 hours at room temperature to decalcify the bony structures. The decalcified cochlear bone was then peeled away to expose the soft tissues of the cochlear duct.

Immunohistochemistry: Decalcified cochlear ducts were permeabilized in 0.5% PBS-Triton (PBST) for approximately 6 hours. Permeabilized tissues were then incubated in mouse anti-CtBP2 IgG1 (pre-synaptic marker; 1:200, BD Biosciences) and one or more of the following antibodies in PBST with 10% normal goat serum (Sigma) overnight at 4° C. with rotation: mouse anti-GluR2 IgG2a (post-synaptic marker; 1:500, Millipore), anti-f3 Tubulin III (neuronal marker; 1:1000, Sigma), or rabbit anti-Myosin VIIa (hair cell marker; 1:1000, Proteus Biosciences). Samples were then rinsed 3× for 15 minutes in PBST then incubated in one or more of the following isotype and species-specific secondary antibodies (1:1000, Life Technologies) in 10% normal goat serum in PBST for 2 hours: Alexa Fluor-488 anti-mouse IgG1, Alexa Fluor-546 anti-mouse IgG2a, Alexa Fluor-633 anti-rabbit IgG, or Alexa Fluor-546 anti-rabbit IgG. Cochlear samples were then rinsed twice in PBST, then incubated in the nuclear label DAPI in PBS (1:3000, Thermo Scientific) for at least 10 minutes before being further dissected and flat mounted onto microscope slides and coverslipped in Fluormount-G (SouthernBiotech) mounting medium.

Quantification: A Zeiss LSM880 laser scanning confocal microscope with a 63× objective was used to image each cochlea at regions corresponding to the position at 25%, 50% and 75% of the total length of the cochlea from the base (basal, middle and apical regions, respectively). Z-stack images were obtained from the basilar membrane to the lumenal surface of the hair cells at 0.35 μm steps. From each image, a region consisting of 6 consecutive inner hair cells was identified and the number of pre-synaptic CtBP2-positive puncta within that XYZ plane was counted, this number was then divided by 6 to obtain the average number of puncta per inner hair cell per region, and these numbers were then averaged for each genotype (wild type and heterozygous).

C57BL/6 mice are known to develop age-related hearing loss that involves reduced numbers of ribbon synapses on inner hair cells of the cochlea that is apparent by 6 months of age. Knock-down of TrkC.T1 in the heterozygous (HET) mice resulted in a larger number of inner hair cell ribbon synapses (puncta/IHC) at all levels of the cochlea (base, mid and apex) compared with wild-type (WT) controls (FIG. 8). These data suggest that TrkC.T1 knock-down is associated with preservation of inner hair cell ribbon synapses in the face of age-related decrements and is evidence of an improvement in auditory function.

Example 4 Development of Selective Inhibitors of TrkC.T1

A short hairpin RNA (shRNA) specifically targeting a unique 3′ sequence of the TrkC.T1 mRNA is designed. The TrkC.T1-targeting shRNA sequence or a scrambled control are cloned into a pLKO.1 lentiviral shRNA-expression vector. pLKO.1^(scrambled) and pLKO.1^(TrkC-T1) lentivirus are purified and tested by infection of HEK293-TrkC.T1 or HEK293-TrkC-FL (cells transfected with TrkC.T1 or TrkC-FL cDNAs). Infection with PLK0.1^(TrkC T 1) reduces TrkC.T1 mRNA without affecting TrkC-FL mRNA, whereas infection with control virus PLKO.1^(Scrambled) has no effect on either TrkC.T1 or TrkC-FL mRNA. The data is verified by studying protein expression in lysates of the same cells. In multiple experiments TrkC.T1 protein expression in culture is reduced by ˜80% to 97%. To assess whether reduction of TrkC.T1 has a biological impact, production of TNF-α is used as a functional endpoint for TrkC.T1 activity.

Example 5

In Vivo Testing of Intratympanic Injection of Auris Sensory Cell with a Pharmaceutical Composition Described herein in a Guinea Pig

A cohort of 21 guinea pigs (Charles River, females weighing 200-300 g) is intratympanically injected with 50 μL of a pharmaceutical formulation described herein, containing 0 to 50% antagonist of truncated TrkC or truncated TrkB. The elimination time course for each formulation is determined. A faster elimination time course of a formulation indicates lower mean dissolution time (MDT). Thus the injection volume and the concentration of an antagonist in a formulation are tested to determine optimal parameters for preclinical and clinical studies.

Example 6 Clinical Trial of an Antagonist of Truncated TrkC or Truncated TrkB as a Treatment for Tinnitus

Active Ingredient: an antagonist of truncated TrkC or truncated TrkB

Dosage: 10 ng delivered in 10 μL of a thermoreversible gel. Release of an antagonist of truncated TrkC or truncated TrkB is controlled release and occurs over thirty (30) days.

Route of Administration: Intratympanic injection

Treatment Duration: 12 weeks

Methodology

-   -   Monocentric     -   Pro sepective     -   Randomized     -   Double-blind     -   Placebo-controlled     -   Parallel group     -   Adaptive

Inclusion Criteria

-   -   Male and female subjects between the 18 and 64 years of age.     -   Subjects experiencing subjective tinnitus.     -   Duration of tinnitus is greater than 3 months.     -   No treatment of tinnitus within 4 weeks.

Evaluation Criteria

-   -   Efficacy (Primary)         -   1. Total score of the Tinnitus Questionnaire     -   Efficacy (Secondary)         -   1. Audiometric measurements (mode, frequency, loudness of             the tinnitus, pure tone audiogram, speech audiogram)         -   2. Quality of Life questionnaire     -   Safety         -   1. Treatment groups are compared with respect to incidence             rates of premature termination, treatment-emergent adverse             events, laboratory abnormalities, and ECG abnormalities.

Study Design

Subjects are divided into three treatment groups. The first group is the safety sample. The second group is the intent-to-treat (ITT) sample. The third group is the valid for efficacy (VIE) group.

For each group, one half of subjects to be given a truncated TrkC or truncated TrkB antagonist and the remainder to be given placebo.

Statistical Methods

The primary efficacy analysis is based on the total score of the Tinnitus Questionnaire in the ITT sample. The statistical analysis is based on an analysis of covariance (ANCOVA) with baseline as covariant and the last observation carried forward value as dependent variable. Factor is “treatment.” The homogeneity of regression slopes is tested. The analysis is repeated for the VIE sample.

Audiometric measurements (mode, frequency, loudness of the tinnitus, pure tone audiogram, speech audiogram) as well as quality of life are also analyzed via the aforementioned model. The appropriateness of the model is not tested. P values are exploratory and are not adjusted for multiplicity.

Example 7

Table 1 illustrates exemplary sequences described herein. The DNA sequences disclosed in Table 1 encodes TrkC shRNAs described herein.

TABLE 1 SEQ ID NOs   1 GGACAATAGAGATCATCTAGT   2 CCGGGGACAATAGAGATCATCTAGTCTCGAGACTAGATGA TCTCTATTGTCCTTTTTG   3 AATTCAAAAAGGACAATAGAGATCATCTAGTCTCGAGACT AGATGATCTCTATTGTCC   4 CCGGGGACATTCCAAGCCTCTTAACCTCGAGGTTAAGAGG CTTGGAATGTCCTTTTTG   5 AATTCAAAAAGGACATTCCAAGCCTCTTAACCTCGAGGTT AAGAGGCTTGGAATGTCC   6 CCGGCATGGTTTCAGAGAAATTATGCTCGAGCATAATTTC TCTGAAACCATGTTTTTG   7 AATTCAAAAACATGGTTTCAGAGAAATTATGCTCGAGCAT AATTTCTCTGAAACCATG 114 GGUAUAAGUGCACACUGAAUA 115 CACUGAAUAGUCUAAUCUACA 116 GAGAGUCAAACAAUGUUAAGG 117 GAGAAGAGUUCUAUGGUUAUC 118 GACAAAGCAGUGUGCUCUAAU 119 GGAUGUGUUUGUACUUGCAGA   8 CCTAAGGTTAAGTCGCCCTCG (control)

Table 2 illustrates sequences of the full-length and truncated isoforms of TrkC and TrkB.

TABLE 2 TrkC Full-length MDVSLCPAKCSFWRIFLLGSVWLDYVGSVLACPANCVCSKTEIN GenBank: CRRPDDGNLFPLLEGQDSGNSNGNASINITDISRNITSIHIENWRSL CAA12029.1 HTLNAVDMELYTGLQKLTIKNSGLRSIQPRAFAKNPHLRYINLSS SEQ ID NO: 9 NRLTTLSWQLFQTLSLRELQLEQNFFNCSCDIRWMQLWQEQGE AKLNSQNLYCINADGSQLPLFRMNISQCDLPEISVSHVNLTVREG DNAVITCNGSGSPLPDVDWIVTGLQSINTHQTNLNWTNVHAINL TLVNVTSEDNGFTLTCIAENVVGMSNASVALTVYYPPRVVSLEE PELRLEHCIEFVVRGNPPPTLHWLHNGQPLRESKIIHVEYYQEGEI SEGCLLFNKPTHYNNGNYTLIAKNPLGTANQTINGHFLKEPFPES TDNFILFDEVSPTPPITVTHKPEEDTFGVSIAVGLAAFACVLLVVL FVMINKYGRRSKFGMKGPVAVISGEEDSASPLHHINHGITTPSSL DAGPDTVVIGMTRIPVIENPQYFRQGHNCHKPDTYVQHIKRRDIV LKRELGEGAFGKVFLAECYNLSPTKDKMLVAVKALKDPTLAAR KDFQREAELLTNLQHEHIVKFYGVCGDGDPLIMVFEYMKHGDL NKFLRAHGPDAMILVDGQPRQAKGELGLSQMLHIASQIASGMV YLASQHFVHRDLATRNCLVGANLLVKIGDFGMSRDVYSTDYYR LFNPSGNDFCIWCEVGGHTMLPIRWMPPESIMYRKFTTESDVWS FGVILWEIFTYGKQPWFQLSNTEVIECITQGRVLERPRVCPKEVY DVMLGCWQREPQQRLNIKEIYKILHALGKATPIYLDILG TrkC Full-length MDVSLCPAKCSFWRIFLLGSVWLDYVGSVLACPANCVCSKTEIN UniProtKB Accession CRRPDDGNLFPLLEGQDSGNSNGNASINITDISRNITSIHIENWRSL Number: Q16288-3 HTLNAVDMELYTGLQKLTIKNSGLRSIQPRAFAKNPHLRYINLSS SEQ ID NO: 110 NRLTTLSWQLFQTLSLRELQLEQNFFNCSCDIRWMQLWQEQGE AKLNSQNLYCINADGSQLPLFRMNISQCDLPEISVSHVNLTVREG DNAVITCNGSGSPLPDVDWIVTGLQSINTHQTNLNWTNVHAINL TLVNVTSEDNGFTLTCIAENVVGMSNASVALTVYYPPRVVSLEE PELRLEHCIEFVVRGNPPPTLHWLHNGQPLRESKIIHVEYYQEGEI SEGCLLFNKPTHYNNGNYTLIAKNPLGTANQTINGHFLKEPFPES TDNFILFDEVSPTPPITVTHKPEEDTFGVSIAVGLAAFACVLLVVL FVMINKYGRRSKFGMKGPVAVISGEEDSASPLHHINHGITTPSSL DAGPDTVVIGMTRIPVIENPQYFRQGHNCHKPDTYVQHIKRRDIV LKRELGEGAFGKVFLAECYNLSPTKDKMLVAVKALKDPTLAAR KDFQREAELLTNLQHEHIVKFYGVCGDGDPLIMVFEYMKHGDL NKFLRAHGPDAMILVDGQPRQAKGELGLSQMLHIASQIASGMV YLASQHFVHRDLATRNCLVGANLLVKIGDFGMSRDVYSTDYYR VGGHTMLPIRWMPPESIMYRKFTTESDVWSFGVILWEIFTYGKQ PWFQLSNTEVIECITQGRVLERPRVCPKEVYDVMLGCWQREPQQ RLNIKEIYKILHALGKATPIYLDILG TrkC Full-length MDVSLCPAKCSFWRIFLLGSVWLDYVGSVLACPANCVCSKTEIN UniProtKB Accession CRRPDDGNLFPLLEGQDSGNSNGNASINITDISRNITSIHIENWRSL Number: Q16288-4 HTLNAVDMELYTGLQKLTIKNSGLRSIQPRAFAKNPHLRYINLSS SEQ ID NO: 111 NRLTTLSWQLFQTLSLRELQLEQNFFNCSCDIRWMQLWQEQGE AKLNSQNLYCINADGSQLPLFRMNISQCDLPEISVSHVNLTVREG DNAVITCNGSGSPLPDVDWIVTGLQSINTHQTNLNWTNVHAINL TLVNVTSEDNGFTLTCIAENVVGMSNASVALTVYYPPRVVSLEE PELRLEHCIEFVVRGNPPPTLHWLHNGQPLRESKIIHVEYYQEGEI SEGCLLFNKPTHYNNGNYTLIAKNPLGTANQTINGHFLKEPFPVD EVSPTPPITVTHKPEEDTFGVSIAVGLAAFACVLLVVLFVMINKY GRRSKFGMKGPVAVISGEEDSASPLHHINHGITTPSSLDAGPDTV VIGMTRIPVIENPQYFRQGHNCHKPDTYVQHIKRRDIVLKRELGE GAFGKVFLAECYNLSPTKDKMLVAVKALKDPTLAARKDFQREA ELLTNLQHEHIVKFYGVCGDGDPLIMVFEYMKHGDLNKFLRAH GPDAMILVDGQPRQAKGELGLSQMLHIASQIASGMVYLASQHF VHRDLATRNCLVGANLLVKIGDFGMSRDVYSTDYYRLFNPSGN DFCIWCEVGGHTMLPIRWMPPESIMYRKFTTESDVWSFGVILWE IFTYGKQPWFQLSNTEVIECITQGRVLERPRVCPKEVYDVMLGC WQREPQQRLNIKEIYKILHALGKATPIYLDILG TrkC Full-length MDVSLCPAKCSFWRIFLLGSVWLDYVGSVLACPANCVCSKTEIN UniProtKB Accession CRRPDDGNLFPLLEGQDSGNSNGNASINITDISRNITSIHIENWRSL Number: Q16288-5 HTLNAVDMELYTGLQKLTIKNSGLRSIQPRAFAKNPHLRYINLSS SEQ ID NO: 112 NRLTTLSWQLFQTLSLRELQLEQNFFNCSCDIRWMQLWQEQGE AKLNSQNLYCINADGSQLPLFRMNISQCDLPEISVSHVNLTVREG DNAVITCNGSGSPLPDVDWIVTGLQSINTHQTNLNWTNVHAINL TLVNVTSEDNGFTLTCIAENVVGMSNASVALTVYYPPRVVSLEE PELRLEHCIEFVVRGNPPPTLHWLHNGQPLRESKIIHVEYYQEGEI SEGCLLFNKPTHYNNGNYTLIAKNPLGTANQTINGHFLKEPFPVD EVSPTPPITVTHKPEEDTFGVSIAVGLAAFACVLLVVLFVMINKY GRRSKFGMKGPVAVISGEEDSASPLHHINHGITTPSSLDAGPDTV VIGMTRIPVIENPQYFRQGHNCHKPDTYVQHIKRRDIVLKRELGE GAFGKVFLAECYNLSPTKDKMLVAVKALKDPTLAARKDFQREA ELLTNLQHEHIVKFYGVCGDGDPLIMVFEYMKHGDLNKFLRAH GPDAMILVDGQPRQAKGELGLSQMLHIASQIASGMVYLASQHF VHRDLATRNCLVGANLLVKIGDFGMSRDVYSTDYYRVGGHTM LPIRWMPPESIMYRKFTTESDVWSFGVILWEIFTYGKQPWFQLSN TEVIECITQGRVLERPRVCPKEVYDVMLGCWQREPQQRLNIKEIY KILHALGKATPIYLDILG TrkC.T1 MDVSLCPAKCSFWRIFLLGSVWLDYVGSVLACPANCVCSKTEIN GenBank: CRRPDDGNLFPLLEGQDSGNSNGNANINITDISRNITSIHIENWRS AAB33112.1 LHTLNAVDMELYTGLQKLTIKNSGLRSIQPRAFAKNPHLRYINLS SEQ ID NO: 10 SNRLTTLSWQLFQTLSLRELQLEQNFFNCSCDIRWMQLWQEQGE AKLNSQNLYCINADGSQLPLFRMNISQCDLPEISVSHVNLTVREG DNAVITCNGSGSPLPDVDWIVTGLQSINTHQTNLNWTNVHAINL TLVNVTSEDNGFTLTCIAENVVGMSNASVALTVYYPPRVVSLEE PELRLEHCIEFVVRGNPPPTLHWLHNGQPLRESKIIHVEYYQEGEI SEGCLLFNKPTHYNNGNYTLIAKNPLGTANQTINGHFLKEPFPES TDNFILFDEVSPTPPITVTHKPEEDTFGVSIAVGLAAFACVLLVVL FVMINKYGRRSKFGMKGPVAVISGEEDSASPLHHINHGITTPSSL DAGPDTVVIGMTRIPVIENPQYFRQGHNCHKPDTWVFSNIDNHGI LNLKDNRDHLVPSTHYIYEEPEVQSGEVSYPRSHGFREIMLNPISL PGHSKPLNHGIYVEDVNVYFSKGRHGF TrkC.T1 MDVSLCPAKCSFWRIFLLGSVWLDYVGSVLACPANCVCSKTEIN UniProtKB Accession CRRPDDGNLFPLLEGQDSGNSNGNASINITDISRNITSIHIENWRSL Number: Q16288-2 HTLNAVDMELYTGLQKLTIKNSGLRSIQPRAFAKNPHLRYINLSS SEQ ID NO: 113 NRLTTLSWQLFQTLSLRELQLEQNFFNCSCDIRWMQLWQEQGE AKLNSQNLYCINADGSQLPLFRMNISQCDLPEISVSHVNLTVREG DNAVITCNGSGSPLPDVDWIVTGLQSINTHQTNLNWTNVHAINL TLVNVTSEDNGFTLTCIAENVVGMSNASVALTVYYPPRVVSLEE PELRLEHCIEFVVRGNPPPTLHWLHNGQPLRESKIIHVEYYQEGEI SEGCLLFNKPTHYNNGNYTLIAKNPLGTANQTINGHFLKEPFPES TDNFILFDEVSPTPPITVTHKPEEDTFGVSIAVGLAAFACVLLVVL FVMINKYGRRSKFGMKGPVAVISGEEDSASPLHHINHGITTPSSL DAGPDTVVIGMTRIPVIENPQYFRQGHNCHKPDTWVFSNIDNHGI LNLKDNRDHLVPSTHYIYEEPEVQSGEVSYPRSHGFREIMLNPISL PGHSKPLNHGIYVEDVNVYFSKGRHGF TrkB isoform c MSSWIRWHGPAMARLWGFCWLVVGFWRAAFACPTSCKCSASR GenBank: IWCSDPSPGIVAFPRLEPNSVDPENITEIFIANQKRLEIINEDDVEA AAB33109.1 YVGLRNLTIVDSGLKFVAHKAFLKNSNLQHINFTRNKLTSLSRK SEQ ID NO: 11 HFRHLDLSELILVGNPFTCSCDIMWIKTLQEAKSSPDTQDLYCLN ESSKNIPLANLQIPNCGLPSANLAAPNLTVEEGKSITLSCSVAGDP VPNMYWDVGNLVSKHMNETSHTQGSLRITNISSDDSGKQISCVA ENLVGEDQDSVNLTVHFAPTITFLESPTSDHHWCIPFTVKGNPKP ALQWFYNGAILNESKYICTKIHVTNHTEYHGCLQLDNPTHMNN GDYTLIAKNEYGKDEKQISAHFMGWPGIDDGANPNYPDVIYED YGTAANDIGDTTNRSNEIPSTDVTDKTGREHLSVYAVVVIASVV GFCLLVMLFLLKLARHSKFGMKGPASVISNDDDSASPLHHISNGS NTPSSSEGGPDAVIIGMTKIPVIENPQYFGITNSQLKPDTFVQHIKR HNIVLKRELGEGAFGKVFLAECYNLCPEQDKILVAVKTLKDASD NARKDFHREAELLTNLQHEHIVKFYGVCVEGDPLIMVFEYMKH GDLNKFLRAHGPDAVLMAEGNPPTELTQSQMLHIAQQIAAGMV YLASQHFVHRDLATRNCLVGENLLVKIGDFGMSRDVYSTDYYR VGGHTMLPIRWMPPESIMYRKFTTESDVWSLGVVLWEIFTYGK QPWYQLSNNEVIECITQGRVLQRPRTCPQEVYELMLGCWQREPH MRKNIKGIHTLLQNLAKASPVYLDILG TrkB.T1 MSSWIRWHGPAMARLWGFCWLVVGFWRAAFACPTSCKCSASR (TrkB isoform b) IWCSDPSPGIVAFPRLEPNSVDPENITEIFIANQKRLEIINEDDVEA GenBank: YVGLRNLTIVDSGLKFVAHKAFLKNSNLQHINFTRNKLTSLSRK AAM77876.1 HFRHLDLSELILVGNPFTCSCDIMWIKTLQEAKSSPDTQDLYCLN SEQ ID NO: 12 ESSKNIPLANLQIPNCGLPSANLAAPNLTVEEGKSITLSCSVAGDP VPNMYWDVGNLVSKHMNETSHTQGSLRITNISSDDSGKQISCVA ENLVGEDQDSVNLTVHFAPTITFLESPTSDHHWCIPFTVKGNPKP ALQWFYNGAILNESKYICTKIHVTNHTEYHGCLQLDNPTHMNN GDYTLIAKNEYGKDEKQISAHFMGWPGIDDGANPNYPDVIYED YGTAANDIGDTTNRSNEIPSTDVTDKTGREHLSVYAVVVIASVV GFCLLVMLFLLKLARHSKFGMKGFVLFHKIPLDG TrkB isoform a MSSWIRWHGPAMARLWGFCWLVVGFWRAAFACPTSCKCSASR Origene Accession IWCSDPSPGIVAFPRLEPNSVDPENITEIFIANQKRLEIINEDDVEA Number: YVGLRNLTIVDSGLKFVAHKAFLKNSNLQHINFTRNKLTSLSRK NP_006171.2 HFRHLDLSELILVGNPFTCSCDIMWIKTLQEAKSSPDTQDLYCLN SEQ ID NO: 120 ESSKNIPLANLQIPNCGLPSANLAAPNLTVEEGKSITLSCSVAGDP VPNMYWDVGNLVSKHMNETSHTQGSLRITNISSDDSGKQISCVA ENLVGEDQDSVNLTVHFAPTITFLESPTSDHHWCIPFTVKGNPKP ALQWFYNGAILNESKYICTKIHVTNHTEYHGCLQLDNPTHMNN GDYTLIAKNEYGKDEKQISAHFMGWPGIDDGANPNYPDVIYED YGTAANDIGDTTNRSNEIPSTDVTDKTGREHLSVYAVVVIASVV GFCLLVMLFLLKLARHSKFGMKDFSWFGFGKVKSRQGVGPASV ISNDDDSASPLHHISNGSNTPSSSEGGPDAVIIGMTKIPVIENPQYF GITNSQLKPDTFVQHIKRHNIVLKRELGEGAFGKVFLAECYNLCP EQDKILVAVKTLKDASDNARKDFHREAELLTNLQHEHIVKFYGV CVEGDPLIMVFEYMKHGDLNKFLRAHGPDAVLMAEGNPPTELT QSQMLHIAQQIAAGMVYLASQHFVHRDLATRNCLVGENLLVKI GDFGMSRDVYSTDYYRVGGHTMLPIRWMPPESIMYRKFTTESD VWSLGVVLWEIFTYGKQPWYQLSNNEVIECITQGRVLQRPRTCP QEVYELMLGCWQREPHMRKNIKGIHTLLQNLAKASPVYLDILG TrkB isoform d MSSWIRWHGPAMARLWGFCWLVVGFWRAAFACPTSCKCSASR (TrkB-T-Shc) IWCSDPSPGIVAFPRLEPNSVDPENITEIFIANQKRLEIINEDDVEA Origene Accession YVGLRNLTIVDSGLKFVAHKAFLKNSNLQHINFTRNKLTSLSRK Number: HFRHLDLSELILVGNPFTCSCDIMWIKTLQEAKSSPDTQDLYCLN NP_001018075.1 ESSKNIPLANLQIPNCGLPSANLAAPNLTVEEGKSITLSCSVAGDP SEQ ID NO: 121 VPNMYWDVGNLVSKHMNETSHTQGSLRITNISSDDSGKQISCVA ENLVGEDQDSVNLTVHFAPTITFLESPTSDHHWCIPFTVKGNPKP ALQWFYNGAILNESKYICTKIHVTNHTEYHGCLQLDNPTHMNN GDYTLIAKNEYGKDEKQISAHFMGWPGIDDGANPNYPDVIYED YGTAANDIGDTTNRSNEIPSTDVTDKTGREHLSVYAVVVIASVV GFCLLVMLFLLKLARHSKFGMKDFSWFGFGKVKSRQGVGPASV ISNDDDSASPLHHISNGSNTPSSSEGGPDAVIIGMTKIPVIENPQYF GITNSQLKPDTWPRGSPKTA TrkB isoform e MSSWIRWHGPAMARLWGFCWLVVGFWRAAFACPTSCKCSASR (TrkB -T-Shc) IWCSDPSPGIVAFPRLEPNSVDPENITEIFIANQKRLEIINEDDVEA Origene Accession YVGLRNLTIVDSGLKFVAHKAFLKNSNLQHINFTRNKLTSLSRK Number: HFRHLDLSELILVGNPFTCSCDIMWIKTLQEAKSSPDTQDLYCLN NP_001018076.1 ESSKNIPLANLQIPNCGLPSANLAAPNLTVEEGKSITLSCSVAGDP SEQ ID NO: 122 VPNMYWDVGNLVSKHMNETSHTQGSLRITNISSDDSGKQISCVA ENLVGEDQDSVNLTVHFAPTITFLESPTSDHHWCIPFTVKGNPKP ALQWFYNGAILNESKYICTKIHVTNHTEYHGCLQLDNPTHMNN GDYTLIAKNEYGKDEKQISAHFMGWPGIDDGANPNYPDVIYED YGTAANDIGDTTNRSNEIPSTDVTDKTGREHLSVYAVVVIASVV GFCLLVMLFLLKLARHSKFGMKGPASVISNDDDSASPLHHISNGS NTPSSSEGGPDAVIIGMTKIPVIENPQYFGITNSQLKPDTWPRGSP KTA TrkB isoform f MSSWIRWHGPAMARLWGFCWLVVGFWRAAFACPTSCKCSASR Origene Accession IWCSDPSPGIVAFPRLEPNSVDPENITEIFIANQKRLEIINEDDVEA Number: YVGLRNLTIVDSGLKFVAHKAFLKNSNLQHINFTRNKLTSLSRK NP_001278866.1 HFRHLDLSELILVGNPFTCSCDIMWIKTLQEAKSSPDTQDLYCLN SEQ ID NO: 123 ESSKNIPLANLQIPNCGLPSANLAAPNLTVEEGKSITLSCSVAGDP VPNMYWDVGNLVSKHMNETSHTQGSLRITNISSDDSGKQISCVA ENLVGEDQDSVNLTVHYHHWCIPFTVKGNPKPALQWFYNGAIL NESKYICTKIHVTNHTEYHGCLQLDNPTHMNNGDYTLIAKNEYG KDEKQISAHFMGWPGIDDGANPNYPDVIYEDYGTAANDIGDTT NRSNEIPSTDVTDKTGREHLSVYAVVVIASVVGFCLLVMLFLLK LARHSKFGMKGFVLFHKIPLDG

Table 3 illustrates miRNA sequences.

TABLE 3 miRNA Sequence SEQ ID NO: 13 let-7b-3p CUAUACAACCUACUGCCUUCCC SEQ ID NO: 14 let-7b-5p UGAGGUAGUAGGUUGUGUGGUU SEQ ID NO: 15 miR-1-3p UGGAAUGUAAAGAAGUAUGUAU SEQ ID NO: 16 miR-1-5p ACAUACUUCUUUAUAUGCCCAU SEQ ID NO: 17 miR-9-3p AUAAAGCUAGAUAACCGAAAGU SEQ ID NO: 18 miR-9-5p UCUUUGGUUAUCUAGCUGUAUG A SEQ ID NO: 19 miR-10a-3p CAAAUUCGUAUCUAGGGGAAUA SEQ ID NO: 20 miR-10a-5p UACCCUGUAGAUCCGAAUUUGU G SEQ ID NO: 21 miR-15a-3p CAGGCCAUAUUGUGCUGCCUCA SEQ ID NO: 22 miR-15a-5p UAGCAGCACAUAAUGGUUUGUG SEQ ID NO: 23 miR-16-1- CCAGUAUUAACUGUGCUGCUGA 3p SEQ ID NO: 24 miR-16-2- CCAAUAUUACUGUGCUGCUUUA 3p SEQ ID NO: 25 miR-16-5p UAGCAGCACGUAAAUAUUGGCG SEQ ID NO: 26 miR-17-3p ACUGCAGUGAAGGCACUUGUAG SEQ ID NO: 27 miR-17-5p CAAAGUGCUUACAGUGCAGGUA G SEQ ID NO: 28 miR-18a-3p ACUGCCCUAAGUGCUCCUUCUG G SEQ ID NO: 29 miR-18a-5p UAAGGUGCAUCUAGUGCAGAUA G SEQ ID NO: 30 miR-20a-3p ACUGCAUUAUGAGCACUUAAAG SEQ ID NO: 31 miR-20a-5p UAAAGUGCUUAUAGUGCAGGUA G SEQ ID NO: 32 miR-24-3p UGGCUCAGUUCAGCAGGAACAG SEQ ID NO: 33 miR-24-1- UGCCUACUGAGCUGAUAUCAGU 5p SEQ ID NO: 34 miR-24-2- UGCCUACUGAGCUGAAACACAG 5p SEQ ID NO: 35 miR-30e-3p CUUUCAGUCGGAUGUUUACAGC SEQ ID NO: 36 miR-30e-5p UGUAAACAUCCUUGACUGGAAG SEQ ID NO: 37 miR-93-3p ACUGCUGAGCUAGCACUUCCCG SEQ ID NO: 38 miR-93-5p CAAAGUGCUGUUCGUGCAGGUA G SEQ ID NO: 39 miR-103a- AGCAGCAUUGUACAGGGCUAUG 3p A SEQ ID NO: 40 miR-103a- AGCUUCUUUACAGUGCUGCCUU 2-5p G SEQ ID NO: 41 miR-103b UCAUAGCCCUGUACAAUGCUGC U SEQ ID NO: 42 miR-106a-3p CUGCAAUGUAAGCACUUCUUAC SEQ ID NO: 43 miR-106a-5p AAAAGUGCUUACAGUGCAGGUA G SEQ ID NO: 44 miR-106b-3p CCGCACUGUGGGUACUUGCUGC SEQ ID NO: 45 miR-106b-5p UAAAGUGCUGACAGUGCAGAU SEQ ID NO: 46 miR-107 AGCAGCAUUGUACAGGGCUAUC A SEQ ID NO: 47 miR-125a-3p ACAGGUGAGGUUCUUGGGAGCC SEQ ID NO: 48 miR-125a-5p UCCCUGAGACCCUUUAACCUGU GA SEQ ID NO: 49 miR-125b-1- ACGGGUUAGGCUCUUGGGAGCU 3p SEQ ID NO: 50 miR-125b-2- UCACAAGUCAGGCUCUUGGGAC 3p SEQ ID NO: 51 miR-125b-5p UCCCUGAGACCCUAACUUGUGA SEQ ID NO: 52 miR-128-3p UCACAGUGAACCGGUCUCUUU SEQ ID NO: 53 miR-128-1- CGGGGCCGUAGCACUGUCUGAG 5p A SEQ ID NO: 54 miR-128-2- GGGGGCCGAUACACUGUACGAG 5p A SEQ ID NO: 55 miR-133a-3p UUUGGUCCCCUUCAACCAGCUG SEQ ID NO: 56 miR-133a-5p AGCUGGUAAAAUGGAACCAAAU SEQ ID NO: 57 miR-133b UUUGGUCCCCUUCAACCAGCUA SEQ ID NO: 58 miR-141-3p UAACACUGUCUGGUAAAGAUGG SEQ ID NO: 59 miR-141-5p CAUCUUCCAGUACAGUGUUGGA SEQ ID NO: 60 miR-149-3p AGGGAGGGACGGGGGCUGUGC SEQ ID NO: 61 miR-149-5p UCUGGCUCCGUGUCUUCACUCC C SEQ ID NO: 62 miR-182-3p UGGUUCUAGACUUGCCAACUA SEQ ID NO: 63 miR-182-5p UUUGGCAAUGGUAGAACUCACA CU SEQ ID NO: 64 miR-188-3p CUCCCACAUGCAGGGUUUGCA SEQ ID NO: 65 miR-188-5p CAUCCCUUGCAUGGUGGAGGG SEQ ID NO: 66 miR-198 GGUCCAGAGGGGAGAUAGGUUC SEQ ID NO: 67 miR-200a-3p UAACACUGUCUGGUAACGAUGU SEQ ID NO: 68 miR-200a-5p CAUCUUACCGGACAGUGCUGGA SEQ ID NO: 69 miR-200b-3p UAAUACUGCCUGGUAAUGAUGA SEQ ID NO: 70 miR-200b-5p CAUCUUACUGGGCAGCAUUGGA SEQ ID NO: 71 miR-204-3p GCUGGGAAGGCAAAGGGACGU SEQ ID NO: 72 miR-204-5p UUCCCUUUGUCAUCCUAUGCCU SEQ ID NO: 73 miR-206 UGGAAUGUAAGGAAGUGUGUGG SEQ ID NO: 74 miR-221-3p AGCUACAUUGUCUGCUGGGUUU C SEQ ID NO: 75 miR-221-5p ACCUGGCAUACAAUGUAGAUUU SEQ ID NO: 76 miR-296-3p GAGGGUUGGGUGGAGGCUCUCC SEQ ID NO: 77 miR-296-5p AGGGCCCCCCCUCAAUCCUGU SEQ ID NO: 78 miR-324-5p CGCAUCCCCUAGGGCAUUGGUG U SEQ ID NO: 79 miR-326 CCUCUGGGCCCUUCCUCCAG SEQ ID NO: 80 miR-330-3p GCAAAGCACACGGCCUGCAGAG A SEQ ID NO: 81 miR-331-3p GCCCCUGGGCCUAUCCUAGAA SEQ ID NO: 82 miR-331-5p CUAGGUAUGGUCCCAGGGAUCC SEQ ID NO: 83 miR-340-3p UCCGUCUCAGUUACUUUAUAGC SEQ ID NO: 84 miR-340-5p UUAUAAAGCAAUGAGACUGAUU SEQ ID NO: 85 miR-345-3p GCCCUGAACGAGGGGUCUGGAG SEQ ID NO: 86 miR-345-5p GCUGACUCCUAGUCCAGGGCUC SEQ ID NO: 87 miR-374a-3p CUUAUCAGAUUGUAUUGUAAUU SEQ ID NO: 88 miR-374a-5p UUAUAAUACAACCUGAUAAGUG SEQ ID NO: 89 miR-374b-3p CUUAGCAGGUUGUAUUAUCAUU SEQ ID NO: 90 miR-374b-5p AUAUAAUACAACCUGCUAAGUG SEQ ID NO: 91 miR-374c-3p CACUUAGCAGGUUGUAUUAUAU SEQ ID NO: 92 miR-374c-5p AUAAUACAACCUGCUAAGUGCU SEQ ID NO: 93 miR-384 AUUCCUAGAAAUUGUUCAUA SEQ ID NO: 94 miR-412-3p ACUUCACCUGGUCCACUAGCCG U SEQ ID NO: 95 miR-412-5p UGGUCGACCAGUUGGAAAGUAA U SEQ ID NO: 96 miR-422a ACUGGACUUAGGGUCAGAAGGC SEQ ID NO: 97 miR-449a UGGCAGUGUAUUGUUAGCUGGU SEQ ID NO: 98 miR-449b-3p CAGCCACAACUACCCUGCCACU SEQ ID NO: 99 miR-449b-5p AGGCAGUGUAUUGUUAGCUGGC SEQ ID NO: 100 miR-449c-3p UUGCUAGUUGCACUCCUCUCUG U SEQ ID NO: 101 miR-449c-5p UAGGCAGUGUAUUGCUAGCGGC UGU SEQ ID NO: 102 miR-485-3p GUCAUACACGGCUCUCCUCUCU SEQ ID NO: 103 miR-509-3p UGAUUGGUACGUCUGUGGGUAG SEQ ID NO: 104 miR-509-5p UACUGCAGACAGUGGCAAUCA SEQ ID NO: 105 miR-509-3- UACUGCAGACGUGGCAAUCAUG 5p SEQ ID NO: 106 miR-617 AGACUUCCCAUUUGAAGGUGGC SEQ ID NO: 107 miR-625-3p GACUAUAGAACUUUCCCCCUCA SEQ ID NO: 108 miR-625-5p AGGGGGAAAGUUCUAUAGUCC SEQ ID NO: 109 miR-765 UGGAGGAGAAGGAAGGUGAUG

The examples and embodiments described herein are for illustrative purposes only and various modifications or changes suggested to persons skilled in the art are to be included within the spirit and purview of this application and scope of the appended claims. 

What is claimed is:
 1. A method of treating an otic disease or condition, comprising administering to a patient in need thereof a therapeutic amount of a pharmaceutical composition comprising: a) a nucleic acid polymer that hybridizes to a target sequence of truncated TrkC or truncated TrkB, wherein the nucleic acid polymer is capable of decreasing the expression level of the truncated TrkC or truncated TrkB; and b) a pharmaceutically acceptable excipient and/or a delivery vehicle.
 2. The method of claim 1, wherein the otic disease or condition comprises a disease or condition associated with hearing loss.
 3. The method of claim 1, wherein the otic disease or condition comprises ototoxicity, chemotherapy induced hearing loss, excitotoxicity, sensorineural hearing loss, noise induced hearing loss, presbycussis, Meniere's Disease/Syndrome, endolymphatic hydrops, labyrinthitis, Ramsay Hunt's Syndrome, vestibular neuronitis, tinnitus, or microvascular compression syndrome.
 4. The method of claim 1, wherein the nucleic acid polymer hybridizes to a target sequence of truncated TrkC.
 5. The method of claim 1, wherein the nucleic acid polymer hybridizes to a target sequence of truncated TrkB.
 6. The method of claim 1, wherein the nucleic acid polymer hybridizes to a target sequence that is located at the 3′UTR region of the truncated TrkC or truncated TrkB mRNA or to a target sequence comprising a binding motif selected from CCAAUC, CUCCAA, or ACUGUG.
 7. The method of claim 1, wherein the nucleic acid polymer comprises a short hairpin RNA (shRNA) molecule, a microRNA (miRNA) molecule, a siRNA molecule, or a double stranded RNA molecule.
 8. The method of claim 1, wherein the nucleic acid polymer comprises at least 80%, 85%, 90%, 95%, 99%, or 100% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119.
 9. The method of claim 1, wherein the nucleic acid polymer is further modified at the nucleoside moiety, at the phosphate moiety, or a combination thereof.
 10. The method of claim 1, wherein the nucleic acid polymer further comprises one or more artificial nucleotide bases.
 11. The method of claim 10, wherein the one or more artificial nucleotide bases comprises 2′-O-methyl, 2′-O-methoxyethyl (2′-0-MOE), 2-O-aminopropyl, 2′-deoxy, T-deoxy-2′-fluoro, 2′-O-aminopropyl (2′-O-AP), 2′-O-dimethylaminoethyl (2′-O-DMAOE), 2′-O-dimethylaminopropyl (2′-O-DMAP), T-O-dimethylaminoethyloxyethyl (2′-O-DMAEOE), or 2′-O-N-methylacetamido (2′-O-NMA) modified, locked nucleic acid (LNA), ethylene nucleic acid (ENA), peptide nucleic acid (PNA), 1′, 5′-anhydrohexitol nucleic acids (HNA), morpholino, methylphosphonate nucleotides, thiolphosphonate nucleotides, or 2′-fluoro N3-P5′-phosphoramidites.
 12. The method of claim 1, wherein the nucleic acid polymer is at most 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 70, 80, 90, or 100 nucleotides in length.
 13. The method of claim 1, further comprising a vector comprising the nucleic acid polymer.
 14. The method of claim 13, wherein the vector is a viral vector selected from a lentiviral vector, a retroviral vector, an adenoviral vector, an adeno-associated viral vector, an alphaviral vector, a herpes simplex virus vector, a vaccinia viral vector, or a chimeric viral vector.
 15. The method of claim 1, wherein the truncated TrkC is a non-catalytic truncated TrkC.
 16. The method of claim 1, wherein the truncated TrkC comprises at least 80%, 85%, 90%, 95%, or 99% sequence identity to the amino acid sequence of SEQ ID NO: 10 or
 113. 17. The method of claim 1, wherein the truncated TrkC is TrkC.T1.
 18. The method of claim 1, wherein the truncated TrkB is a non-catalytic truncated TrkB.
 19. The method of claim 1, wherein the truncated TrkB comprises at least 80%, 85%, 90%, 95%, or 99% sequence identity to an amino acid sequence selected from SEQ ID NOs: 11-12 and 121-123.
 20. The method of claim 1, wherein the truncated TrkB is TrkB.T1.
 21. The method of claim 1, wherein the truncated TrkC binding partner comprises a neurotrophin or a microRNA molecule and the truncated TrkB binding partner comprises a neurotrophin.
 22. The method of claim 1, wherein the pharmaceutical composition is administered for intramuscular, intratympanic, intravenous, intracochlear, or subcutaneous administration.
 23. An isolated and purified nucleic acid polymer comprising at least 80%, 85%, 90%, 95%, 99% or 100% sequence identity to a nucleic acid sequence selected from SEQ ID NOs: 1-5 and 114-119.
 24. The isolated and purified nucleic acid polymer of claim 23, wherein the isolated and purified nucleic acid polymer is further modified at the nucleoside moiety, at the phosphate moiety, or a combination thereof.
 25. A pharmaceutical composition comprising an isolated and purified nucleic acid polymer of claims 23; and a pharmaceutically acceptable excipient and/or a delivery vehicle.
 26. The pharmaceutical composition of claim 25, further comprising a poloxamer.
 27. The pharmaceutical composition of claim 26, wherein the pharmaceutical composition has between about 14% to about 21% by weight of the poloxamer.
 28. The pharmaceutical composition of claim 26, wherein the pharmaceutical composition has between about 15% to about 17% by weight of the poloxamer.
 29. The pharmaceutical composition of claim 26, wherein the poloxamer is poloxamer
 407. 